ADHD Atten Def Hyp Disord (2011) 3:77234 DOI 10.

1007/s12402-011-0058-y

ABSTRACTS

Springer-Verlag 2011

3rd International Congress on ADHD From Childhood to Adult Disease

26 29 May 2011 Berlin Germany

Editors: Manfred Gerlach, Wurzburg, Germany Peter Riederer, Wurzburg, Germany Andreas Warnke, Wurzburg, Germany

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Introduction
In the name of the World Federation of ADHD it is our pleasure to welcome you here in Berlin to the 3rd International Congress on ADHD: from Childhood to Adult Disease. After the incredible success of the Vienna meeting two years ago almost 2,000 participants from 70 countries attended Berlin is the ideal setting to elucidate and discuss the current advances in basic science and clinical research that contribute to our understanding of ADHD as a lifespan disorder. In this volume, abstracts for the Plenary Sessions (PS) and Hot Topic Symposia (HT) precede the poster (P) abstracts. Submitted abstracts are not edited in any way. The PS are organised in ve topics in the following sequence: Update on Diagnosis, Classication and Aetiology of ADHD in Childhood, Adolescence and Adulthood; Update on Neurobiology of ADHD; Course, Differential Diagnosis and Co-morbidity of ADHD; Update on Treatment of ADHD in Childhood, Adolescence and Adults; Persistence of ADHD: Brain Imaging, Genetics, and Treatment. The 16 HT cover the latest clinical and research developments in the expanding eld of ADHD and related disorders. We are pleased to report that we have received more than 500 poster abstracts, the largest number ever since the World Federation of ADHD began the series of congresses in 2007. We organised the 41 Guided Poster Tours so that presentations of the different topic categories are represented uniformly. The general topic headings are those of Aetiopathogenesis, Biomarker Candidates, Co-morbidity, Diagnosis, Epidemiology, Experimental Models, Genetics, Imaging, Life Quality, Miscellaneous, Non-Pharmacological Treatment, Pathophysiology, and Pharmacological Treatment. We would like to encourage you to not only view these selected posters, but to also engage in an active discussion and exchange of ideas with our young colleagues. The abstracts submitted by young scientists have been read by the Scientic Programme Committee to select the eight most meritorious. The authors of these abstracts have been invited to deliver a presentation during the two Young Scientists Award Sessions (YSS). This approach is intended to highlight the importance of original scientic contributions of young colleagues at the congress. We thank all the speakers, contributors, and sponsors of the 3rd International Congress on ADHD: From Childhood to Adult Disease and welcome you to what we are sure will be a very enjoyable and highly informative congress.

Andreas Warnke Congress President President World Federation of ADHD

Manfred Gerlach Chairman Scientic Programme Committee

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Friday, 27 May 2011, 08.3010.30 PS-01 Update on diagnosis, classication and aetiology of ADHD in childhood, adolescence and adulthood
PS-01-01 Key clinical developments relating to the diagnosis of ADHD L. A. Rohde* * Porto Alegre, Brazil Objective: To present and discuss recent research data on controversial clinical aspects of ADHD diagnosis in modern nosological systems. Method: A comprehensive non-systematic review of papers related to clinical aspects of ADHD diagnosis that need to improve in future classication systems. Results: The following aspects are addressed: developmental approach during childhood & adolescence, dimensional approach, compatibility between DSM/ICD, cultural adequacy of wording and thresholds, gender adjustments, inclusion of neurobiological or neuropsychological markers, Weight of all symptoms to capture the latent construct, ADHD types, age-of-onset of impairment, integration different information sources, exclusion of ADHD diagnosis in PDD, challenges for the diagnosis of ADHD in adults. Conclusion: Although ADHD is an extremely well investigated disorder with superior validity over most mental disorders and even over several medical conditions, several clinical aspects should be better conceptualized in future classication systems.

PS-01-03 Are sensation seeking and hyperactivity in both ADHD and mania reecting an autoregulatory attempt to stabilize wakefulness (vigilance)? U. Hegerl*, P. Schonknecht, T. Hensch, S. Olbrich, M. Kluge, C. Sander * Leipzig, Germany Objective: Attention Decit Hyperactivity Disorder (ADHD) and mania show broad symptom overlap and high comorbidity exists between ADHD and bipolar disorder. A recently presented vigilance regulation concept suggests that in both ADHD and mania an unstable wakefulness (vigilance) regulation is a central pathogenetic factor leading to attention decits and, in vulnerable subjects, additionally to hyperactive, impulsive and sensation-seeking behaviour. The latter behavioural pattern is interpreted as an autoregulatory attempt to stabilize wakefulness by increasing external stimulation (1,2). Indeed, under quiet resting conditions, both patients with ADHD and mania show rapid drops to lower vigilance stages (e.g. assessed by an EEGalgorithm of vigilance, VIGALL). Interestingly, the opposite is found in patients with major depression who show a sensation avoidance behaviour (3). In both ADHD and mania, sleep decits aggravate the dysregulation of vigilance as well as the symptomatology indicating that the unstable vigilance is not a consequence of mania or ADHD but a causal pathogenetic factor. Further lines of evidence supporting the vigilance regulation concept of ADHD and mania will be presented. The concept explains the therapeutic effects of psychostimulants in ADHD by their vigilance stabilizing properties. There is scattered but surprisingly strong evidence that psychostimulants are not detrimental in acute mania but might have similar rapid therapeutic effects as observed in ADHD (4). The therapeutic role of methylphenidate in acute mania will be studied in an international controlled trial. 1) Hegerl et al. 2010, Current Opinion in Psychiatry 2) Hegerl et al. 2009, Pharmacopsychiatry 3) Hegerl et al. 2011, World J Biol Psychiatry 4) Schonknecht et al. 2010, Biol Psychiatry

PS-01-02 Different psychopathological dimensions in adult ADHD M. Rosler*, W. Retz * Homburg, Germany Objective: The diagnosis of Attention Decit Hyperactivity Disorder (ADHD), as described by DSM-IV, is based on 3 major psychopathological symptom domains: inattention, hyperactivity and impulsivity. The question remains open whether the DSM-IV symptoms are adequate to fully characterize adult ADHD. Several authors (e.g. Wender) have suggested that the picture of the adult disorder may somewhat different from the childhood and adolescent situation. There is an ongoing discussion about the relation of emotional dysregulation and disorganization and adult ADHD respectively. Method: This is about a review concerning diagnostic concepts elaborated particularly for the use in adult ADHD. Moreover we report on clinical treatment studies refering to the responsiveness of the symptoms of emotional dysregulation and disorganization. Results: The prevalence of symptoms of emotional dysregulation and of disorganization is on the same level as the classical symptoms of inattention, hyperactivity and impulsivity in clinical populations. Both groups of symptoms show a favourable response to pharmacological treatment. The observed effect sizes are not different from those of the classical symptoms. Conclusion: There is growing evidence that emotional dysregulation and disorganisation are intrinsic components of the psychopathology of adult ADHD.

PS-01-04 Environmental inuences in ADHD J. Buitelaar* * Nijmegen, The Netherlands Objective: To critically review the evidence for environmental inuences on ADHD. Method: Systematic review of primary papers and reviews retrieved by a search on papers published in PubMed in the years 1990-2010 Results: Twin studies indicate that genetic factors do not entirely explain the phenotypic manifestation and the developmental course of ADHD (Burt, 2009). About 30% of the variance in ADHD traits is due to either unique or shared environmental factors (Wood et al., 2010). Among the environmental factors found to be relevant for the development of ADHD are, in particular, pregnancy and delivery complications, low birth weight, premature birth, and exposure to toxins in utero (e.g. nicotine and alcohol) and childhood (e.g. lead) (see for a review Banerjee et al., 2007). Psychosocial adversity (e.g. parental psychopathology, deprivation and parenting factors) are also of importance (e.g. Biederman et al., 2002a; Stevens et al., 2009; Buschgens et al., 2008). A critical review of the evidence for a role of environmental factors related to ADHD indicates however that reects various methodological limitations of the literature (Linnet et al., 2003; Banerjee et al., 2007; Coghill & Faraone, 2010). For

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80 some factors there is sufcient evidence from the literature (premature birth) or suggestive evidence (low birthweight and maternal smoking) that they play a role. For others there is (yet) insufcient evidence (alcohol, drugs, psychopathology parents, delivery problems, severe head injury, deprivation and psychosocial adversity) for their causal relationship with ADHD. Studies into environmental inuences are complicated by gene-environment correlation, and gene-environment interaction. These may lead to underestimate the effect size of environmental inuences. Conclusion: The study of environmental inuences has not kept pace with the developments in studying genetic inuences in ADHD. (fMRI) studies in adults with ADHD and pharmacological fMRI studies investigating the effect of single doses of methylphenidate and atomoxetine on task-related brain activity. Method: This review is based on a systematic literature search and research of our group in Cambridge. Results: There is converging evidence from structural and functional neuroimaging supporting the model of neurodevelopmental decits in fronto-striatal networks modulated by dopamine (and noradrenaline). Conclusion: More and better replicated ndings are needed in order to replace speculative interpretations by consolidated evidence.

Friday, 27 May 2011, 11.0012.30 PS-02 Update on neurobiology of ADHD

PS-02-01 Genetic contribution to the development of ADHD: Current state of the art B. Franke* * Nijmegen, The Netherlands Objective: ADHD is highly heritable in children and adults. ADHD has a multifactorial etiology, in which both genetic and environmental factors contribute to disease risk. In most cases, the individual genetic factors are common in the population and have only a small effect size, suggesting that hundreds of genetic variants contribute to disease in the individual patient. Recent evidence also implicates rare variants of larger effect size as disease cause in a yet unknown percentage of patients. Method: In my presentation, I will review the current knowledge of ADHD genetics, with a focus on the persistence of the disorder along the lifespan and on the utility of intermediate phenotypes for the characterization of the effects of genetic risk factors as well as for gene-nding purposes. Results: Candidate gene-based and genome-wide genetic studies have identied a small number of genes involved in ADHD. Using bioinformatics, it has been possible to identify neurite outgrowth as an important biological process in ADHD etiology. First results of studies on adult ADHD suggest that different alleles of a gene may contribute to ADHD in children and adults, and that not all genes for ADHD in childhood also predispose to adult ADHD. Recent work by our group shows that structural and functional neuroimaging is highly suited to unravel the biological pathways from gene to disease in ADHD, and that structural neuroimaging phenotypes are useful intermediate phenotypes in the search for novel ADHD risk genes. Conclusion: The eld of ADHD genetics is rapidly evolving an many new insights into the etiology of this disorder can be expected to come from such research. Large collaborative genome-wide analyses of both common and rare genetic variants continue to be a very important tool in this research, as the data currently available do not yet afford optimal power for gene nding.

PS-02-03 Neurophysiology of ADHD T. Banaschewski* * Mannheim, Germany Objective: The millisecond time resolution of electrophysiology provides a noninvasive method to monitor neural activation patterns associated with a wide variety of brain states and processes in real time. Spatial resolution has increased considerably through source imaging and combined EEG-fMRI. In addition, real time feedback of neural activity has found increasing therapeutic applications in neurofeedback and brain computer onterfaces. Specic brain functions underlying attention, inhibition, or response control can be separated with adequate ERP tasks and EEG/ERP studies can reveal both psychophysiological precursors and correlates of behavioural impairment. Method: Recent electrophysiological research on response inhibition, working memory, motivation, reward and emotion processing in ADHD and the inuence of medication is reviewed. Results: Event-related potentials indicating attentional orienting, preparation and response control revealed multiple attention and regulation problems rather than isolated inhibition decits in ADHD and help disentangling the pathophysiological background of the comorbidity with oppositional deant disorder/conduct disorder. Abnormal brain activity related to performance monitoring and error detection has been found in children, adolescents and adults with ADHD. Familial effects on deviant EEG/ERP parameters indicate that theses parameters could be considered as putative endophenotypes. Recent studies of resting-state functional connectivity indicate that altered spontaneous very low frequency brain activity may interfere with higher cognitive functions. Conclusion: Over the past decade, EEG/ERP research has contributed substantially to our understanding of altered brain processes and functions underlying ADHD. Although decient response inhibition has been proposed as the core decit in ADHD, electrophysiological studies show that ADHD cannot be fully explained by an inhibitionspecic decit. EEG/ERP and multimodal imaging studies are promising tools for multilevel investigations of etiological pathways into ADHD, and neurophysiological markers become increasingly important as targets for treatment.

PS-02-02 Imaging brain structure and function in ADHD U. Muller* * Cambridge, United Kingdom Objective: Neuroimaging research has increased our understanding of neurobiological mechanisms underlying clinical symptoms of ADHD and their response to treatment with stimulants and other pharmacological interventions. In my presentation I will review structural MRI studies in adults with ADHD, radioligand studies with PET and SPECT imaging of the dopamine system, functional MRI

Saturday, 28 May 2011, 08.3010.30 PS-03 Course, differential diagnosis and co-morbidity of ADHD
PS-03-01 ADHD and Borderline personality disorders A. Fossati, Italy

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81 PS-03-02 ADHD and autism C. Freitag* * Frankfurt, Germany Objective: ADHD and Autism Spectrum Disorders show considerably phenotypic overlap. Recent studies in twins reported shared and disorder specic genetic and environmental risk factors. Shared biological and psychosocial risk factors and features have rarely been assessed. Method: The present talk will give an overview on studies on ADHD and Autism Spectrum Disorders, present new data, and will discuss areas of clinical importance and research needs. Results: There is a scarcity of studies comparing both childhood onset disorders on the phenotypic, neuropsychological, neurobiological and genetic level. Most studies were performed on neuropsychological measures. Conclusion: The clinical overlap but also the differential diagnosis of ADHD and Autism Spectrum Disorders needs to be studied further, and specic treatment studies are mandatory. Justice System. UK prison studies have indicated a rate of 43% in youths and 24% in male adults screening positive for a childhood history, 14% of whom had persisting symptoms. Those with persisting symptoms had a signicantly younger onset of offending and higher rate of recidivism. ADHD was the most important predictor of violent offending, even above substance misuse. They accounted for 8-fold more critical incidents than other prisoners. Critical incidents have also been associated with personality disordered patients screening positive for ADHD and detained under the Mental Health Act. It is the mood instability associated with ADHD that most likely increases the risk of critical incidents within institutional settings and these behavioural problems might therefore be expected to respond to treatments that reduce levels of ADHD symptoms. With this in mind, the treatment needs of ADHD offenders will be considered and data on the effectiveness of the revised R&R2 offending behaviour programme for ADHD youths and adults will be presented.

Sunday, 29 May 2011, 08.3010.30 PS-04 Update on treatment of ADHD in childhood, adolescence and adults
PS-04-01 Optimizing individually tailored pharmacotherapy in children and adolescents D. Coghill* * Scotland, United Kingdom Objective: To describe the evidence supporting individually tailoring medication treatments for ADHD and suggesting practical clinical approaches to putting the evidence into practice. Method: Review the evidence presented in recent systematic reviews of pharmacotherapy for ADHD and clinical practice guidelines and the various options for putting this evidence into practice within routine clinical settings. Results: Current evidence supports the notion that whilst remission is an achievable goal for many individuals with ADHD many clinicians appear to be satised with some improvement rather than optimised treatment. Studies of stimulant medications suggest that it is difcult to predict who will and wont respond to treatment and for those that do it is not possible to predict what dose will result in the best response. Similarly it is not possible to predict who will and will not suffer adverse effects with ADHD medications. The results of the MTA study suggest several approaches to treatment that may help optimise treatment. Accurate titration is important but is only the rst stage of treatment and it is equally important to remain focused during the continuing care phase. Conclusion: It is possible to develop and implement clinical protocols that aim to optimise pharmacological treatments for ADHD within routine clinical settings. Focussing on ADHD care pathways rather than ADHD teams may be a helpful way forward for some services and may aid transition between services.

PS-03-03 ADHD and decient emotional regulation S. Faraone* * Syracuse, USA Objective: A growing body of research suggests that decient emotional self-regulation (DESR) is prevalent and morbid among patients with ADHD. The diagnostic and prognostic utility of DESR symptoms is complicated by the occurrence of emotional symptoms in disorders that are comorbid with ADHD such as oppositional deant disorder and mood disorders. Thus, we sought to clarify the independent contribution of ADHD to DESR and the clinical implications of DESR using family study methodology. Method: Two independent studies are presented: a family study of ADHD youth and a family study of ADHD adults. For the study of youth, subjects were 197 children with and 224 without ADHD and 128 siblings We dened DESR if a child had an aggregate cut-off score of [ 180 but less than 210 on the Anxiety/Depression, Aggression, and Attention scales of the Child Behavior Checklist. For the adult study, 206 Adults with ADHD or ADHD NOS (late onset) and 123 Adults without ADHD. We assessed DESR with items from Barkleys Current Behavior Scale. All subjects and family members in both studies were comprehensively assessed with structured diagnostic interviews and a wide range of functional measures. Results: The results were essentially the same for the child and adult studies. DESR predicted increased levels of impairment and psychiatric comorbidity and the association of ADHD with DESR was independent of psychiatric comorbidity. DESR was independent of psychometric measures of neuropsychological dysfunction. The familial transmission of DESR suggests it may be a familial subtype of ADHD and is not a familial expression of other Axis I DSM-IV disorders, or of non-familial environmental factors. Conclusion: DESR is a familially transmitted emotional component of ADHD that is independent of ADHDs known comorbidities with other psychiatric disorders and neuropsychological dysfunction.

PS-04-02 ADHD through the life cycle PS-03-04 ADHD and antisocial behaviour M. Weiss* S. Young* * London, United Kingdom Objective: Research suggests there is a disproportionately high concentration of individuals with ADHD involved with the Criminal * Vancouver, Canada Objective: To identify developmental challenges found at each stage of the life cycle and demonstrate how patients can be assisted with negotiating each of these transitions.

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82 Method: Symptoms are recurring patterns which dene diagnosis, however, we need to look beyond core symptoms to functioning, adaptive life skills, executive function, and quality of life to understand why there are consistent patterns that characterize each stage of the life cycle. Results: Preschoolers are often most hyperactive and impulsive, and therefore will require increased supervision. Latency places new demands for attention as the child has to do homework and requires forced effort to attend to what they nd boring as well as organizational skills. Despite these difculties many latency aged children with ADHD will have a positive illusory bias. Educational adaptations can allow academic performance to approach actual potential for achievement. Adolescence demands delayed gratication, the capacity to hold consequences in mind, a desire for peer acceptance, and even greater demands for efciency, self care, and ability to prioritize and set long term goals. Quality of life of ADHD in adolescents with ADHD may actually decline, and high risk behaviors become more common. Adults with ADHD often carry scars in self esteem from childhood, and will over the years develop insight and coping strategies that can be worked with in group or individual therapy. Conclusion: When ADHD is viewed longitudinally with multiple dimensions of outcome it becomes evident that while medication is valuable in remediating core symptoms, development can only be understood by also looking at multiple dimensions of outcome. Pills do not build skills. Treatment is by necessity multimodal and includes ongoing support and follow up. The result of this type of care is a patient who is able to compensate for their ADHD to achieve their full potential and a good quality of life. are targeted, the specic mechanisms involved, and the contribution of learned control over specic brain functions and states to the clinical outcome are less clear. Method: The review will cover recent evidence regarding the neurophysiological rationale for, and the specic and nonspecic mechanisms of neurofeedback treatment in ADHD. Selected papers, reviews and metaanalyses are examined for strengths and limitations of the approach. Results: There are sizeable, sustained and partly specic effects of neurofeedback treatment compared to partly matched control treatments, but nonspecic effects are still not sufciently addressed, and comparisons to genuine placebo treatments are largely lacking. Conclusion: The discussion will focus on the importance of specic treatment effects. It will cover the relative merits of different suitable controlled designs including placebo control, the advances and clarications expected from ongoing trials, and important areas for future research. The sizeable clinical effects of neurofeedback treatment consist of both specic and nonspecic contributions. This warrants intense further research to understand both elements, to improve the specic efcacy of neurofeedback, and to optimize training schedules.

Sunday, 29 May 2011, 11.0013.00 PS-05 Persistence of ADHD: Brain imaging, genetics and treatment
PS-05-01 Brain correlates of adult outcome in children with ADHD

PS-04-03 What do we know about psychotherapeutic treatment in adult ADHD? A. Philipsen* * Freiburg, Germany Objective: Adult ADHD is a serious risk factor for co-occuring disorders and negative psychosocial consequences. Given this background, in addition to psychopharmacological treatment there is a need for effective psychotherapeutic treatment options for adults with ADHD. Results: Previous trials on psychotherapeutic concepts were based on cognitive behavioural and/or dialectical behavioural approaches and showed signicant effects and benets for the patients. Targets of psychotherapeutic interventions are coping with the core symptoms, associated problems, comorbidities, but also probable consequences like low self esteem and interpersonal problems. Improvements of ADHD symptomatology and associated symptoms (e.g. depression, anxiety) have been reported after psychotherapeutic treatment. There is preliminary evidence for a signicantly greater benet of a combination therapy with medication and psychotherapy. The group setting per se and support by other participants is regarded as strongly helpful. Conclusion: In the lecture an overview of evaluated individual and group therapy programs in adult ADHD is given and conclusions derived from available data are discussed.

F. X. Castellanos*, E. Proal, P. Reiss, R. Klein, S. Mannuzza, J. Lerch, Y. He, A. Zijdenbos, C. Kelly, M. Milham * New York, USA Objective: Volumetric studies have reported relatively decreased cortical thickness and gray matter volumes in adults with ADHD whose childhood status was retrospectively recalled. We present the rst prospective study combining cortical thickness and voxel-based morphometry (VBM) in adults diagnosed with ADHD in childhood. In adults who had Combined Type ADHD in childhood, we sought to 1) test whether they exhibit cortical thinning and decreased gray matter density in regions hypothesized related to ADHD, and 2) test whether anatomic differences are associated with current ADHD diagnosis, including persistence versus remission. Method: Cross-sectional analysis embedded in a 33-year prospective follow-up at mean age 41. Participants were ADHD probands from a cohort of 207 6-12 year old Caucasian boys; male comparison subjects (n=178) had been free of ADHD in childhood. We obtained MRI scans in 59 probands and 80 comparisons (28% and 45% of original samples, respectively). Results: Cortex was signicantly thinner and less dense in ADHD probands than comparisons in the dorsal attentional network and limbic areas (FDR\0.05, corrected). Additionally, gray matter density was signicantly decreased in probands in right caudate, right thalamus and bilateral cerebellar hemispheres. Probands with persistent ADHD (n=17) did not differ signicantly from remitters (n=26) at FDR\0.05. At uncorrected p\0.05, remitters had thicker cortex relative to those with persistent ADHD in medial occipital cortex, insula, parahippocampus, and prefrontal regions. Conclusion: We observed anatomic gray matter reductions in adults with childhood ADHD, regardless of current diagnosis. The most affected regions underpin top-down control of attention and regulation of emotion and motivation. Exploratory analyses suggest that amelioration and diagnostic remission may result from compensatory

PS-04-04 Efcacy of neurofeedback training D. Brandeis*, R. Drechsler * Zurich, Switzerland Objective: A number of recent controlled studies have established sizeable and sustained therapeutic effects of neurofeedback training in children with ADHD. However, the neurophysiological decits which

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83 maturation of prefrontal regions and cerebellar-thalamo-striatal circuitry. develop ADHD (OR= 2.46, 95% CI 1.63-3.70, p = 5.09 9 10-6). Additionally, the LPHN3-11q interaction depicts signicantly better the effect that the LPHN3 susceptibility variant has on both, the response to ADHD stimulant medication and brain metabolism. PS-05-04 Novel treatments for ADHD H. Abikoff* * New York, USA Objective: Difculties in organization, time management, and planning (OTMP) are prominent features of Attention Decit Hyperactivity Disorder (ADHD) and impact functioning as early as 3rd grade. We posited that these difculties reect organizational skills decits. An Organizational Skills Training (OST) intervention was found effective in a pilot study. To evaluate OSTs efcacy, we conducted a randomized controlled trial that included a wait-list (WL) control and a performance-based contingency-management intervention (Parents and Teachers Helping Kids get organized; PATHKO), which precluded skills-training and targeted and rewarded OTMP end-point behaviors. Method: The trial, done in the U.S. at New York University and Duke University Medical Center, randomly assigned 3rd-5th grade boys and girls with ADHD and OTMP decits to OST, PATHKO, or WL. Each treatment involved 20 one-hour twice-weekly clinic sessions. OST involved working primarily with the child, whereas PATHKO sessions occurred primarily with the parent. Outcome domains included OTMP functioning, academic functioning, homework behaviors, and family relations. Results: 180 children entered the study. Completions rates were high (OST = 96%, PATHKO = 92%, WL = 100%). Extensive evidence of efcacy was obtained for both interventions, with most signicance levels at p \ .0001, and effect sizes ranging from .63 to 2.80. Almost two-thirds of the children in each treatment group no longer met entry criteria for OTMP decits vs. 6% of controls (p \ .0001). OST was superior to PATHKO on parent ratings of organizational functioning (p \ .001) and family conict (p \ .05). On all other outcomes, OST and PATHKO were comparable. Parents and teachers were satised with both treatments. Conclusion: Robust treatment effects were obtained for childrens organizational functioning at home and school and on other key functional domains. The skills-based and performance-based treatments show promise of broad clinical applicability with elementary school-aged children with ADHD and OTMP decits.

PS-05-02 Using structural neuroimaging to understand clinical outcome in ADHD P. Shaw*, W. Sharp, M. Malek, J. Rapoport * Bethesda, USA Objective: To delineate the neuroanatomic correlates of variable clinical outcome in Attention Decit Hyperactivity Disorder. Method: Setting: US Federal Research Institute. Subjects: Observational study of 145 children with DSM-IVR dened combined type ADHD (mean age at study entry 11.2 years) were followed longitudinally, with repeated neuroanatomic imaging on a 1.5T GR scanner and clinical assessments into adolescence (mean age at last assessment 17.2, SD 2.5 years). Comparison was made with age, sex and IQ matched typically developing youth with no DSM-IV diagnoses. Linear mixed model regression was used to delineate the developmental trajectories of the cerebral cortex, cerebellum and hippocampus/amygdala and basal ganglia. Results: ADHD which remitted by adolescence was associated with a signicant convergence towards the trajectories of typical development in the cerebral cortex and cerebellum. By contrast, persisting ADHD with full persistence was associated with progressive divergence from typical trajectories. Subjects with partial remission showed an intermediate pattern. Conclusion: Variable clinical outcome of ADHD in adolescences is accompanied by distinct neurodevelopmental trajectories. Improving symptomatology is reected or perhaps driven by a convergence towards typical trajectories, whereas clinical persistence is accompanied by progressive neurodevelopmental deviation.

PS-05-03 Attention Decit Hyperactivity Disorder: From Understanding Genetics to Treatment M. Muenke* * Bethesda, MD, USA Objective: Attention Decit Hyperactivity Disorder (ADHD) is the most common behavioral disorder of childhood with a high heritability. Using pedigrees from a genetic isolate we previously described linkage and association to a handful of loci (4q, 5q, 8q, 11q, and 17p) (Arcos-Burgos et al., AJHG 75:998, 2004). Recently, we identied LPHN3, a novel ADHD susceptibility gene in 4q: we showed that a common variant in LPHN3 confers susceptibility to ADHD and predicts effectiveness of stimulant medication (Arcos-Burgos et al., Mol Psych 15:1053, 2010). Here we explore the interaction between this and additional ADHD-associated loci. Method: We screened for potential interactions between ADHDlinked loci, conditioned on the LPHN3 associated SNPs, and used case-control and family-based association test (FBAT) designs. Results: We found a signicant correlation between 4q and 11q (p\1 9 10-8). Furthermore, we detected interacting effects with a haplotype in 11q (p\5 9 10-6). This haplotype encompasses the gene for neural cell adhesion molecule 1 (NCAM1) that has a fundamental role in neural development, and it is adjacent to the dopamine receptor D2 (DRD2), a gene previously associated with ADHD. Using three additional ADHD datasets, that previously showed association of ADHD to LPHN3, the LPHN3-11q interaction was replicated by formal meta-analysis. Conclusion: The effect of the LPHN3-11q interaction represents a two-fold increase from the original risk conferred by LPHN3 to

Saturday, 28 May 2011, 11.0012.30 PCD-01 The psychostimulant is not dangerous for the patients
PCD-01-01 Proponent L. Greenhill* * New York, USA Abstract not received

PCD-01-02 Opponent K. W. Lange* * Regensburg, Germany

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84 Abstract: Methylphenidate is the most frequently prescribed stimulant drug in the treatment of attention decit disorder and has been the focus of much controversy, since a number of harmful methylphenidate-related effects have been observed. In most cases, the side effects are mild but some can be life-threatening. Methylphenidate has been reported to cause sudden death in children and teenagers, especially in subjects with heart defects or serious heart problems. Exposure to methylphenidate and amphetamines salts appears to have similar risks for cardiac emergencies. The ever increasing prescription of methylphenidate has led to non-medical and illicit use (such as cognitive neuroenhancement and brain doping) which is likely to cause a variety of consequences including addiction, negative reactions and medical complications. Method: We performed a literature review and analysis of published and unpublished family and twin studies of ADHD in adults. Results: We found that ADHD tends to aggregate in families and that there are signicant familial associations between parent and offspring ADHD. However not all studies show signicant parent-offspring associations for ADHD. For twin studies we nd that heritability estimates drop from around 70-80% during childhood and adolescence to around 30-40% during adulthood. However these ndings are rater dependent, with higher estimates of heritability and parent-offspring associations for ADHD derived from informant data than with selfratings. Since twin studies of ADHD symptoms in adults have all used self-rating scales, we cannot exclude the possibility that the observed decline in heritability represents a rater effect. Furthermore, bivariate genetic correlations between inattention and hyperactivity-impulsivity remain stable across the lifespan. We further show preliminary evidence that self-ratings are confounded by adult onset ADHD symptoms that show no familial association with childhood onset ADHD. Conclusion: Heritability estimates are lower in adults than during childhood or adolescence, but this may be accounted by rater effects and the onset of ADHD symptoms during adulthood that are aetiogically distinct from childhood onset ADHD. The underlying genetic architecture of ADHD remains stable throughout the lifespan. Further work is needed to clarify the causal inuences on ADHD in adults.

Thursday, 26 May 2011, 13.0014.30 HT-01 IMpACT symposium on adult ADHD

HT-01-01 Brachiating along the developmental trajectory on the persistence of intermediate ADHD phenotypes B. Franke* * Nijmegen, The Netherlands Objective: The genetics of adult ADHD is still largely uninvestigated and only few genes for severe form of the disorder have been identied. Investigation of intermediate phenotypes may help provide novel candidate genes for further testing. Method: In my group, we use intermediate phenotype approaches at the level of ADHD symptom severity, neuropsychological functioning and functional/structural neuroimaging for the identication of novel genes involved in adult ADHD. In addition, we use these intermediates for the characterization of the biological pathways along which these genes increase ADHD risk. Results: As for gene-to-disease pathway mapping I will present (among others) our ndings on the NOS1 Ex1f VNTR, suggesting that this risk factor for ADHD actually exerts its effect on disease risk by acting on impulsivity, a hallmark of ADHD. This is observed both, at the level of neuropsychological performance and of striatal brain activity during an reward anticipation task. As for gene-nding using intermediate phenotypes, I will show evidence of the usefulness of population-based adult ADHD symptom scores, as these have marked effects on brain structure, in this case total brain volume, similar to effects observed in patients with ADHD. Using the intermediate phenotype of adult total brain volume in a genome-wide association study, we have identied novel candidates for further study in adult ADHD. Conclusion: Intermediate phenotypes are useful for gene-nding in adult ADHD as well as for mapping of the mechanisms by which genetic ADHD risk factors increase disease risk.

HT-01-03 You can always blame your mother: How maternal genotype contributes to offspring ADHD J. Haavik*, S. Johansson, A. Halmy, J. McKinney, I. winge, P. Knappskog * Bergen, Norway Objective: Animal research and human studies have identied multiple signalling molecules that are involved in embryonic brain development and that deciency of these factors may lead to longterm adverse effects on brain development and function. One such signalling molecule is serotonin that is a classical neurotransmitter and recently has been shown to be a humoral trophic factor essential for embryonic development. Method: Adult outpatients with ADHD, their family members and random controls were recruited all across Norway. To determine whether genetically determined deciency of serotonin or other maternal growth factors is associated with symptoms of ADHD or related neuropsychiatric disorders in offspring, we performed targeted resequencing of the gene involved in serotonin biosynthesis in peripheral tissues (TPH1) in 741 individuals, as well whole exome sequencing in a subgroup of 12 pedigrees. We identied eight pedigrees with TPH1 mutations carriers. Information about psychiatric diagnoses and symptoms were obtained from all participants and 419 additional controls. All mutant TPH1 variants were expressed in E. coli and human cell lines, puried and subjected to systematic biochemical characterization. Results: Of the seven different TPH1 coding variants that were detected in 38 persons, six variants had signicantly decreased stability or activity in vitro compared to wild type enzyme. Offspring of mothers carrying TPH1 mutations reported much higher ADHD scores than controls, or offspring of fathers with the corresponding TPH1 mutations (p \ 0.001). Exome sequencing revealed several additional candidate genes and mutations that similarly could be involved in embryonic brain development. Conclusion: An impaired maternal serotonin production may have profound long-term behavioural effects on their offspring, independent of the childrens own TPH1 genotypes. Exome sequencing in large pedigrees, combined with high-throughput functional characterization of candidate genes is a promising technology to obtain new insights into pathogenic mechanisms of complex disorders, including the effects of maternal genotypes on offspring behaviour.

HT-01-02 Measuring the heritability of adult ADHD P. Asherson*, A. Merwood, H. Larsson *London, United Kingdom Objective: ADHD tends to aggregate in families and is known to be a highly heritable phenotype during childhood and adolescence. Yet population twin studies of ADHD symptoms in adults nd much lower estimates of heritability; around half the heritability estimated during the childhood and adolescent years. Here we review family and twin studies of ADHD in adults to investigate the potential reasons for the decline in heritability estimates throughout the lifespan.

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85 HT-01-04 Expanding the phenotype - shared risk genes for bipolar disorder and adult ADHD A. Reif* * Wurzburg, Germany Objective: Several GWAS on bipolar disorder (BPD) suggested novel risk genes. However, only few of them were followed up and the specicity of these genes is elusive. On the other hand, linkage analyses implicated the 9q22 region in Attention Decit Hyperactivity Disorder (ADHD). This locus contains the brain-expressed GTP-binding RASlike 2 gene (DIRAS2). There is accumulating evidence for neurobiological overlap with of ADHD with BPD, with a high percentage of adult ADHD patients also suffering from BPD and vice versa. Method: To address these specicity of the risk genes implicated in the studies mentioned above, we genotyped ANK3, CACNA1C, DGKH, and EGFR, which were signicantly associated with BPD in previous GWAS, in a sample of 380 BPD patients. Replicated SNPs were then followed up in patients suffering from unipolar depression (UPD, n=387) or adult ADHD (n=535). Furthermore, we conducted an association study with respect to DIRAS2 in 600 patients suffering from adult ADHD. Replication samples consisted of 1035 adult ADHD and 336 BPD patients. Results: While we could not conrm association of ANK3, CACNA1C and EGFR with BPD, 6 SNPs in DGKH were associated with disease, two of them surviving correction for multiple testing. All of them were associated with UPD or aADHD. Furthermore, a haplotype was associated with all disorders. Four DIRAS2 SNPs and two haplotype blocks showed evidence of association with ADHD. In the replication samples, we obtained a consistent effect of rs1412005 and a risk haplotype. Meta-analysis resulted in a signicant common OR of 1.12 for rs1412005 and conrmed association with the risk haplotype (OR=1.45, p=0.0003). rs1412005 also increased risk towards BPD. Conclusion: We demonstrate an association of DGKH and DIRAS2 with BPD and ADHD by applying two-stage designs. The considerable dimensional overlap between them thus might be partially explained on the molecular level by genetic variation in these risk genes. 2001). With SPM8b one-sample t-tests will be performed to determine activations within groups using the individual contrast images anticipation of gain[anticipation of no-gain and anticipation of loss[ anticipation of no-loss. ANOVA for dependent measures will be used to compare these contrasts between drug-nave and medicated patients. Analyzes will explore BOLD signals in controls relative to ADHD. Results: Preliminary: Independent of medication status, 8 patients showed higher activation in anterior and posterior cingulate, ventral striatum, insula as well as hippocampus during anticipation of loss. During anticipation of gain patients showed signicant activation in the ACC, brain stem, cerebellum and premotor cortex. MPH-intake was associated with lower effect sizes during positive and negative reward conditions. Results comparing ADHD patients and healthy controls will be presented. Conclusion: Preliminary results suggest ventral striatal brain activation during the anticipation of gain as well as loss in children with ADHD, independent of medication status. MPH-intake seems to be correlated with lower activations in reward related structures.

HT-02-02 Reward processing in male adults with childhood ADHD a comparison between drug-nave and methylphenidatetreated subjects M. S. Stoy*, L. Schlochtermeier, F. Scxhlagenhauf, U. Lehmkuhl, M. Huss, A. Heinz, A. Strohle * Berlin, Germany Objective: We examined reward processing in adulthood depending on treatment with Methylphenidate (MPH) in subjects with Attention Decit Hyperactivity Disorder (ADHD) during childhood. Method: 11 males with childhood-ADHD treated with MPH, 12 drug-nave males with childhood-ADHD and 12 controls matched by age, handedness and smoking behavior were investigated drug-free in a functional magnetic resonance imaging study using a monetary incentive delay task. As regions of interest we choose the ventral striatum (VS) during anticipation and the orbitofrontal cortex (OFC) during outcome. Results: Our ANOVA did not reveal any signicant effect of group during the anticipation and outcome of gain. Controls, drug-nave and treated subjects did not signicantly differ in their activations in the VS and OFC. Interestingly, whole-brain analyses revealed a decreased activation in the insula in response to loss-outcome in drug nave subjects in comparison to controls and treated subjects. In contrast, subjects with MPH treatment did not show signicant differences compared to controls. Brain activation in the insula correlated signicantly positive with harm avoidance. Conclusion: Our ndings indicate normalizations in the reward system independently of MPH-pretreatment in subjects previously diagnosed with childhood-ADHD. Differences between treated and drug-nave ADHD subjects underpin the need of prospective studies on long-term effects of psychostimulant treatment.

Thursday, 26 May 2011, 13.0014.30 HT-02 Reward processing in children and adults with ADHD
HT-02-01 Reward processing in children with Attention Decit Hyperactivity Disorder - a comparison between drug-naive and methylphenidate-treaded subjects and healthy controls V. Jucksch*, A. Beck, H. Salbach-Andrae, A. Strohle, U. Lehmkuhl * Berlin, Germany Objective: Neuroimaging studies have postulated dysfunctions in the mesolimbic reward system in patients with ADHD (Strohle et al., 2008; Scheres et al., 2010). While performing a monetary incentive delay task (MID; Knutson et al., 2001), patients with ADHD showed reduced ventral striatal activation during reward anticipation. Methylphenidate (MPH) acutely modulates neural activity during response inhibition tasks within PFC and striatum (Rubia et al., 2009). Therefore we examine: 1) brain activity and reward processing in healthy children compared to those with ADHD, and 2) the neural basis of symptom improvement in ADHD after treatment with MPH. Method: 15 children with ADHD and 15 controls were enrolled. Each participant underwent two fMRI sessions, while ADHD patients were drug-nave and after they had received MPH for at least 4 weeks. During each fMRI session, participants performed a MID task (Knutson et al.

HT-02-03 A reward task for simultaneous EEG-fMRIneuroimaging: Pilot results for a study with ADHD children I. Wolf*, M. Plichta, S. Rechtsteiner, S. Hohmann, C. Diener, P. Meyer, M. Zangl, M. Ruf, C. Niemeyer, D. Gass, S. Heike, D. Mier, P. Kirsch, H. Flor, A. Meyer-Lindenberg, T. Banaschewski, M. Holtmann, D. Brandeis * Germany Objective: Simultaneous recording of fMRI (functional magnetic resonance imaging) and EEG (electro encephalogram) is increasingly used

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86 to study cognitive and motivational states in basic and clinical neuroscience. We now use this combined measurement technique to learn more about the human reward system involving several neural substrates forming a complex brain network. Simultaneous recordings require modications of the original fMRI reward to improve signal to noise ratio for EEG. One aim of the present study was thus to nd out whether the fMRI core results would prove robust in the modied paradigm, while resolving potential technical problems which may occur when combining both methods in challenging motivational paradigms. Method: Based on previous work of Kirsch et al. (2003) we modied a reward anticipation task for the use with EEG (requiring a button press after a visual cue), which is known to reliably activate ventral striatal brain structures. EEG data and fMRI images were simultaneously acquired in a 3T MRI Siemens TIM Trio scanner from 20 healthy participants (20 to 26 years) using an event related design. Money gained of the reward task was paid after the fMRI-Session. Results: We found a stronger BOLD signal in the ventral striatum during anticipation of reward. The robust activation of the brain reward system in our modied monetary incentive task conrms that neither simultaneous fMRI-EEG, nor the corresponding task modications diminished sensitivity in detecting ventral striatal BOLD-responses. The analyses revealed meaningful ERPs with signicant differences between both conditions (win money/no money) developing during early (\1s) as well as late ([1s) stages of reward anticipation. Conclusion: Showing that simultaneous combination of both methods produced good data quality concerning electrophysiology and hemodynamic response future work will concentrate on data fusion of both techniques to fully utilize the complementary information brought by EEG to fMRI and vice versa. HT-02-04 Altered reward processing in ADHD: Information from fMRI and NIRS A. Fallgatter*, M. M. Plichta, S. Heinzel, A.-C. Ehlis * Tubingen, Germany Objective: The reward system is considered a relevant part of the brain network disturbed in ADHD. Delay discounting is a particular form of reward processing related to impulsivity and is operationalized as the preference for smaller-but-sooner over later-but-larger rewards. Delay discounting can be measured with intertemporal choice paradigms. Moreover, neural structures involved in delay discounting (e.g. the ventral-striatum and the orbitofrontal cortex) are highly innervated by dopaminergic neurons. Method: We employed the functional imaging methods Near-Infrared Spectroscopy (NIRS) and functional Magnetic Resonance Imaging (fMRI) in order to measure brain function during intertemporal choice paradigms in groups of healthy subjects and patients with ADHD. Behavioral measures of impulsivity were employed. Dopaminergic neurotransmission was assessed by a genetic polymorphism (Val158Met) in the gene of the catechol-O-methyltransferase, which has been shown to alter the dopamine bioavailability. Results: NIRS measurements in healthy subjects indicated a dopamine-related increase of function from low (low DA level) to partial (intermediate DA level) and full (high DA level) reward delay sensitivity within the orbitofrontal cortex. Furthermore, DAbioavailability was shown to moderate the association of neural reward delay sensitivity and impulsivity: reward delay sensitivity in the orbitofrontal cortex was strongly correlated with impulsivity at intermediate dopamine levels, but not at low or high dopamine levels where impulsivity was related to delay-independent activation of the orbitofrontal cortex. Functional MRI investigations suggested a hyporesponsiveness of the ventral striatal reward system in patients with ADHD as compared to healthy controls for both immediate and delayed rewards. In contrast, delayed rewards evoked hyperactivation in the dorsal caudate nucleus and the amygdala of ADHD patients. Conclusion: These data support the conception of a close link between delay discounting, brain activation and dopaminergic neurotransmission. In particular, the results implicate that studies on neural correlates of delay discounting should account for the dopamine bioavailability.

Thursday, 26 May 2011, 13.0014.30 HT-03 Progress in understanding and treatment of ADHD - a neurobiological perspective
HT-03-01 Neuronal inhibition and its modulation by TMS neurotherapeutic perspectives for ADHD S. Bender* * Dresden, Germany Objective: The inhibition of unwanted movements is a core problem in Attention Decit Hyperactivity Disorder (ADHD). Transcranial magnetic stimulation (TMS) is a compelling method to assess and inuence inhibition in the brain. What can TMS tell us about inhibitory decits in ADHD? Can these decits be ameliorated by a TMS intervention (repetitive TMS)? Method: We assessed an inhibitory component of the EEG-response to TMS in 8-14-year-old ADHD children and whether a TMS intervention would inuence this inhibition marker (N100). Results: We found a reduced N100 in ADHD children. During a 1-Hz TMS intervention, there was a signicant further decrease and no normalization of this inhibitory EEG-response. There were no signicant effects on hyperactive behaviour with this TMS-protocol. Conclusion: The EEG-response to TMS reveals inhibition decits in ADHD and is an excellent marker to monitor TMS-intervention effects - because TMS protocols must be optimized in order to ameliorate behavioural symptoms.

HT-03-02 Candidate genes in ADHD the importance to elucidate differential functional effects T. Renner*, C. Roser, A.-C. Ehlis, T. Hahn, J. Christian, T. Nguyen, M. Gerlach, A. Fallgatter, A. Warnke, K.-P. Lesch * Wurzburg, Germany Objective: Altered neurotransmission plays a major role in the pathophysiology of ADHD. Molecular genetic approaches aim to reveal new candidates and their specic impact on functional levels. In a differential approach we aimed to elucidate the potential role of KCNJ6, a gene involved in monoaminergic neurotransmission, in the pathophysiology of ADHD, especially in cognitive functions and reward processes. Method: ssociation between KCNJ6 and ADHD was investigated in a family based sample (n=111) and an adult case-control sample (n=450/426). Further, the inuence of rs7275707 on brain activation of ADHD patients (n=183) and healthy controls (n=118) during a continuous performance test (EEG) and in healthy probands (n=53) during reward conditions (fMRI) was assessed. Results: Association was found in the family-based design, but not in the adult case-control sample. A specic effect of rs7275707 on brain activation in ADHD patients and a general inuence on reward related activation was detected.

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87 Conclusion: Though association with the general ADHD phenotype was not conrmed, our results indicate a specic inuence of KCNJ6 on brain activation in ADHD and a role as general modulator in reward processes. impairments in vigilance/sustained attention and working memory. Impairments of these functions appear therefore to be the most reliable neuropsychological markers of ADHD. However, meta-analyses have shown that a considerable number of studies failed to nd these differences between patients with ADHD and healthy individuals. Furthermore, effect sizes indicated only small to moderate differences between patients with ADHD and healthy participants. Conclusion: Although there is convincing evidence of cognitive dysfunctioning in ADHD, there is no clear, valid and reliable neuropsychological test prole sensitive or specic for ADHD. Individuals with ADHD have unique proles of neuropsychological functioning, with some patients showing impairments in one function and other patients displaying decits in another function. On group level, patients may differ from healthy participants with regard to cognitive functioning. However, there is no neuropsychological marker that is distinctive regarding the individual diagnosis of ADHD. HT-04-02 Olfaction in ADHD and comorbid disorders M. Romanos*, M. Schecklmann, M. Gerlach * Munchen, Germany Objective: Various neuropsychiatric disorders such as ADHD are associated with specic alterations in olfactory function. Dopaminergic dysfunction is suggestive to underlie these observations. Olfaction may be a phenotypic marker for neurobiological alterations related to specic neuropsychiatric disorders. Method: Here we summarize recent clinical and functional imaging investigations on olfaction in ADHD and associated neuropsychiatric disorders. Results: Alterations in olfactory function are widely prevalent in neuropsychiatric disorders, although distinct domains and aspects of olfaction are differentially affected in the respective disorders. Modulation of neurotransmission by central nervous medication inuences olfactory function. Increased olfactory sensitivity seems to be specic for childhood ADHD. Conclusion: We suggest increased olfactory sensitivity as promising state marker of ADHD that is modulated by stimulant medication and normalizes during temporal development of the disorder. Olfactory function may be a useful biomarker for diagnosis, differential diagnosis and treatment monitoring of ADHD.

HT-03-03 Neural correlates of processing emotional stimuli in children and adolescents with ADHD: An fMRI study on serotonergic modulation F. Zepf*, B. Herpertz-Dahlmann, T. Gaber, K. Helmbold, S. Bubenzer, D. Baurmann * Aachen, Germany Objective: Children and adolescents with ADHD often show covarying problems in affective regulation. The neurotransmitter serotonin (5-HT) has been linked to affective and emotional processes, with evidence coming from human studies involving adults and pharmacological studies using the administration of SSRIs. However, studies in children and adolescents are scarce, and it is not known how an acute central nervous decit in 5-HT synthesis affects affective and emotional processes in adolescents with ADHD. The present study investigated the effects of an acutely diminished central nervous 5-HT synthesis in combination with functional magnetic resonance imaging (fMRI) in order to study the neural correlates of processing emotional stimuli in adolescents with ADHD. Method: Male patients with ADHD aged 9-17 years received the rapid tryptophan depletion-test (RTD) Moja-De in a double-blind within-subject crossover-design. They participated on two days in the investigation, with the two testing days spaced 7 days apart. On one day they received the RTD-test Moja-De within an amino acid drink lacking tryptophan (TRP), the physiological precursor amino acid of 5-HT, thus leading to a diminished central nervous 5-HT synthesis. On a second day they received a TRP balanced amino acid mixture as a control condition. Under depletion/the control condition the participants had to do an emotional word-face matching task in an fMRI environment (Siemens Trio, 3T) in a rapid event-related task design. Results: We will show imaging data on the serotonergic modulation of brain regions involved while the subjects performed the emotional word-face matching paradigm. Conclusion: Implications for neurocircuitries involved in affective and emotional processing will be discussed.

Thursday, 26 May 2011, 14.3016.00 HT-04 Biomarker candidates for the diagnosis, longterm course and therapeutic management of ADHD
HT-04-01 Neuropsychological assessment O. Tucha* * Groningen, The Netherlands Objective: While neuropsychological measures are no biomarkers stricto sensu, they nevertheless full some of the criteria of classical biomarkers such as the objective measurement of processes that have the potential to indicate the presence of a pathology, physiological alteration, decit or psychological condition. This presentation aims to give an overview of cognitive decits of patients with Attention Decit Hyperactivity Disorder (ADHD) and to evaluate the use of neuropsychological assessment in the diagnosis of ADHD. Results: Decits in all domains of cognitive functioning have been reported in children and adults with ADHD. However, these ndings are inconsistent across studies. The most robust ndings are

HT-04-03 Transcranial brain sonography in children and adults with hyperkinetic movement disorders J. Buchmann* * Rostock, Germany Abstract: Transcranial (TBS) sonography, measuring the echogenicity in distinct brain regions, provides a simple and secure approach, very suitably for children. Alterations in the echogenicity of the basal ganglia are discussed as a possible pathophysiological substrate in movement disorders (Becker 1995, Walter 2002). Furthermore, it is assumed that pediatric neuropsychiatric disorders with hyperkinetic movements like ADHD could be pathophysiologically linked to malfunctions of distinct target brain regions, e.g. basal ganglia (caudate nucleaus - CN) or the echogenic size of the substantia nigra (SN) (Krauel et al. 2010, Romanos 2010). Less is known about other pediatric neuropsychiatric movement disorders. We investigated tic/tourette children and found correlations (preliminary results) between echogenic size/echogenicity of CN and SN with motorcortical excitability, both related to the YGTSS score. The contribution provides a brief overview of evidence in transcranial brain sonography in pediatric neuropsychiatric disorders and introduces selected results of its own.

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88 HT-04-04 Biomarker research mRNA and protein expression analyses R. Taurines*, M. Romanos, M. Schecklmann, T. Renner, E. Grunblatt, S. Walitza, J. Thome, A. Warnke, M. Gerlach * Wurzburg, Germany Objective: In the absence of objective clinical characteristics, the identication of peripheral biomarkers in neuropsychiatric disorders is highly relevant for the diagnostic process and an individualized therapy. In our studies we analyzed mRNA-expression of candidate genes (BDNF, DRD4, DRD5, TPH1) in peripheral tissue of patients with Attention Decit Hyperactivity Disorder (ADHD) and autism spectrum disorders (ASD) searching for possible molecular markers for these disorders. BDNF expression was additionally assessed on the protein level. Method: Serum and mRNA was obtained from children and adolescents with ADHD and ASD ( comorbid ADHD), diagnosed according to ICD10 criteria, as well as healthy controls. mRNA expression was determined via quantitative realtime PCR, serum BDNF concentrations via ELISA. Results: From the realtime PCR, DRD4-mRNA levels differed signicantly with lower transcript levels in ADHD and ASD children (75% comorbid with ADHD) compared to healthy controls. ASD patients revealed a decreased DRD5 mRNA expression in comparison to the two other groups and a lower BDNF mRNA expression compared to controls. Decreased BDNF expression in ASD patients was conrmed on the protein level. Conclusion: Alterations in mRNA and protein expression patterns in peripheral tissue are potential biomarkers which might in the future facilitate an early diagnosis and differential diagnosis of ADHD and ASD. Sensitivity and specicity of these possible markers have to be determined in future studies in larger cohorts and patients with further neuropsychiatric disorders. HT-05-02 The European network adult ADHD P. Asherson*, S. J. Kooij * London, United Kingdom Objective: The European Network Adult ADHD (ENAA) was established as a network of psychiatrists and psychologists, experienced in clinical management and research of adults with ADHD (A-ADHD). Method: ENAA was established in 2003 and included 40 professionals from 18 countries across Europe. Results: ENAA successfully established an international network of experts. The group has been particularly concerned that due to the lack of recognition and use of appropriate treatments, many adults with ADHD are misdiagnosed and prevented from receiving effective treatments; leading to unnecessary suffering for individuals and their families. To address this issue ENAA published a European consensus statement on diagnosis and treatment of A-ADHD (Kooij et al., 2010). The statement was reviewed and agreed by ENAA members following three meeting between 2003 and 2009 and review of the published literature. ENAA also serves to support local initiatives. For example, Asherson and colleagues established the UK Adult ADHD Network (www.ukaan.org.uk). UKAAN has developed training courses for the diagnosis and treatment of A-ADHD; and has organised meetings and expert workshops on the delivery of clinical services, ADHD in the criminal justice system, ADHD and addiction, ADHD and occupational health and the role of neuropsychology. UKAAN will also host the rst ENAA conference for ADHD across the lifespan (London, September 21. 22), which focuses on aetiology, clinical course, diagnosis and treatment of ADHD in the adult years; and will be preceded by a workshop for ENAA and other professionals involved in national and international clinical and research initiatives for A-ADHD. Conclusion: A-ADHD remains a condition that is not adequately recognised or treated in many European countries. ENAA provides essential support for the development of clinical practice and research for A-ADHD, leading to improvements in the treatment of this common and often severe mental health disorder. Conclusion: CADDRA has set a model now being replicated, The creation of such networks will raise awareness of ADHD, allow for access to care through family practice, provide ongoing education of physicians, and continue systematic lobbying for ADHD to be recognized as one of the leading mental health conditions requiring care.

Thursday, 26 May 2011, 14.3016.00 HT-05 Networking the adult networks

HT-05-01 CADDRA, the Canadian network M. Weiss*, A. Vincent * Vancouver, Canada Objective: The objective of CADDRA was to network the experts in ADHD from across the country to 1. advocate for ADHD in medical education 2. create a national ADHD continuing education program 3. generate a world class national ADHD conference so that local clinicians would be exposed to the cutting edge of new research, and 4. to create user friendly practice guidelines to establish a uniform minimal standard of care. Method: The symposium will review the logistics of how the organization was created so it can be duplicated in other countries. We will present our successes in collaborating with patient advocacy groups, and for reimbursement of medication. We will review the format, role, and structure of the third edition of the guidelines and the use or our website for publication of the guidelines and to create a membership. Results: Physicians representing both languages, all provinces, and all specialties organized the executive board. CADDRA is now incorporated as a non prot organization with bylaw that insure its ongoing structures for the future. Our national, annual conferences have been well attended with presentations by world class speakers so as thus inform local clinicians of the cutting edge of new research and methods of practice. Unique aspects of our practice guidelines is that they are both printed and web based, they are continuously updated, and they include an ADHD toolkit that makes it possible for a general practitioner to assess and treat ADHD, with free rating scales appropriate to all ages.

HT-05-03 The Latin American network E. Barragan* * Mexico, Mexico Objective: To explain the objetives and impacts in the adult networking in latinamerica Method: We analyze the diagnosis of adult ADHD in LA using the LatinAmerican survey for ADHD, the major comorbilities in our region and the rst lines of treatment. Results: We proposed to used a regionalized screenig tool adapted to our necesities, as well, to the rst line treatments fo adults in latinamerican treatment guides. In these, we concluded that methyphenidate and atomoxetine in combination with a cognitive therapy are the best choice of treatment. Conclusion: In LA, ADHD in adults its not well recognized. We need to improve diffusion and have a more educational labor with people dedicated to Adult mental health. The treatment in adults have a good efcacy and its well tolerated.

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89 HT-05-04 APSARD, the USA network A. Rostain* * Philadelphia, PA, USA Abstract not received they did not present with signicant antisocial comportment in childhood. When ages 18, 25 and 41, they and 178 boys without ADHD were blindly assessed. The developmental sequence leading to substance abuse will be presented. Results: Through adulthood, at age 41, the greatest risk factor for substance abuse and dependence is Antisocial Personality Disorder which originated de novo during adolescence. Conclusion: Among children with ADHD who did not have conduct disorders when diagnosed, substance abuse and dependence follows a clear developmental pattern. Abuse of drugs appears mediated by the development of antisocial disorders.

Thursday, 26 May 2011, 14.3016.00 HT-06 International Collaboration on ADHD and substance abuse (ICASA, www.adhdandsubstanceabuse.org)
HT-06-01 ADHD and substance abuse: Clinical and pharmacological perspectives W. van den Brink* * The Netherlands Abstract not received

HT-06-04 ADHD and substance abuse: Challenges for harm minimisation S. Kaye* * Sydney, Australia Objective: The harms associated with substance use disorders (SUD) are well documented and have a wide impact, particularly on physical, psychological and social functioning. SUD are associated with poorer physical and psychological health, increased criminal activity, increased risk of violent offending and victimisation, and a range of risk-taking behaviours. Risk behaviours that are particular features of SUD include harmful routes of drug administration (e.g. injecting), blood-borne virus risk behaviours (e.g. needle-sharing; unsafe sex practices), and high-risk driving behaviours (e.g. speeding; dangerous driving; driving under the inuence of alcohol/drugs). Psychiatric comorbidity is highly prevalent among those with SUD, who have higher rates of mood, anxiety and personality disorders than the general population. Depending on the nature of the comorbid disorder, this can result in a range of complications for the course and treatment of SUD. In the case of comorbid ADHD, the vulnerability to those harms already inherent in the use of alcohol and other drugs is likely to be increased. Those with ADHD may be at greater risk of SUD-related harm due to the inattention, carelessness, and impulsive behaviour that are associated with ADHD. In addition to various treatment interventions targeted toward the cessation or reduction of substance abuse, public health strategies designed to reduce the harm associated with SUD have been developed and implemented in many countries. The presence of comorbid ADHD, however, poses particular challenges to the implementation and effectiveness of these strategies. Difculties with reading, attention and information processing may reduce the effectiveness of educational programs and information resources, whilst impulsivity may affect compliance with harm minimisation protocols and recommendations. This presentation will entail a discussion of these, and other, implications of comorbid ADHD for SUD harm minimisation.

HT-06-02 ADHD and substance abuse: A genetic perspective J. A. Ramos-Quiroga* * Barcelona, Spain Objective: Cocaine is the second most used illegal drug in Europe. The transition from use to dependence involves both genetic and environmental factors. Genetic variation in neurotransmitter systems is involved in the susceptibility to cocaine dependence and ADHD. We examined the possible contribution to cocaine dependence of 15 genes involved in the cellular machinery that controls neurotransmitter release: genes encoding proteins of the SNARE complex (STX1A, SNAP25, VAMP1 and VAMP2), fusion control elements (SYT, SYT2, CPLX1, CPLX2, CPLX3 and CPLX4) and regulatory elements (STXBP1, SYP, SNPH, NSF, and RAB3A). Method: We genotyped 121 SNPs, selected according to genetic coverage criteria, in 360 cocaine-dependent patients and 360 controls from Spain Results: Single and multiple-marker analyses revealed a strong association between cocaine dependence and the NSF gene, encoding the N -ethylmaleimide-sensitive factor (P _ 5.1e-04, OR _ 2.44 (1.45 4.00) and P _ 0.001, OR _ 1.82 (1.28 2.59), respectively). The presence and absence of psychotic symptoms were also studied. Interestingly, when we considered the time between initial consumption and the onset of cocaine dependence, we observed that the association was mainly restricted to the group of patients that rapidly developed drug dependence (_ 2 years; P _ 2.98e-06, OR _ 1.33 (1.20 1.47)). Conclusion: Our data show preliminary evidence that NSF may predispose not only to cocaine dependence, but also to an early onset of the dependence.

Thursday, 26 May 2011, 14.3016.00 HT-07 Structural, functional and neurochemical correlates of adult ADHD: Do they differ from childhood?
HT-07-01 Structural correlates of adult ADHD: Do they differ from childhood ADHD? K. Konrad* * Aachen, Germany Objective: Unlike in other psychiatric disorders, the majority of neuroimaging studies on structural brain abnormalities in ADHD has included children and adolescents. However, more recently a number

HT-06-03 ADHD and substance abuse: A longitudinal perspective R. G. Klein* * New York, USA Objective: The objective is to elucidate the developmental trajectory from childhood ADHD to substance abuse through adulthood. Method: A cohort of 207 boys were systematically diagnosed with ADHD when they were between 6 and 12 (Mean, 8). Importantly,

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90 of studies addressed structural correlates of ADHD in adults including analyses of both grey and white matter development across the lifespan. Method: We will summarize anatomical ndings on between-group differences comparing ADHD and control subjects across all age groups. Different imaging techniques (MRI, DTI) as well as different methods of data analyses (VBM, Cortical thinning, ROI volumetry, etc.) will be briey introduced. Where possible, data from voxel-wise meta-analyses will be presented. Results: Across studies results demonstrate rather widespread grey matter (GM) abnormalities in structural brain development with regional GM increases and decreases as well as white matter decreases. Effect sizes were largest for GM reductions in prefrontal cortex. However, across age groups anatomical brain differences seem to be relatively consistent within the development and non-progressive with respect to GM differences. Findings for WM differences were more preliminary due to the small number of DTI studies. Conclusion: Stable anatomical brain differences in subjects with ADHD across the life-span in particular in regions of the brain that are involved in attention and executive control support the concept that ADHD is a biological disorder. Possible reasons for heterogenous ndings (such as methodological differences, effects of comorbidity and treatment, multiple etiological pathways, endophenotypes, and age-dependent compensatory processes) will be discussed. Objective: Brain imaging studies revealed dysfunctions during several cognitive processes in patients with ADHD. Diverse cognitive and emotional processes are considered as biological markers of altered brain function in ADHD. Method: Based on their superior time resolution, electrophysiological methods like Event-Related Potentials (ERPs) are adequate for the measurement of fast occuring brain functions. Near-Infrared Spectroscopy (NIRS) is superior to other methods of neuroimaging with regard to an ecological setting allowing even tasks requiring verbal responses. Functional Magnetic Resonance Imaging (fMRI) is the method of choice when spatial localization of brain processes is in the focus of interest. We employed ERP, NIRS and fMRI during different cognitive and emotional tasks in healthy subjects as well as in patients with ADHD. Results: Results indicate a dysfunction of the medial prefrontal cortex comprising the anterior cingulate cortex (ERP), the lateral prefornatl cortex (NIRS) and striatum and amygdale (fMRI) in ADHD patients. Recent studies showed a signicant inuence of variants of dopaminergic as well as serotonergic genes on such measures of brain function (imaging genetics). Conclusion: These results exemplify the advantages of a multimodal neurophysiological assessment with different neuroimaging methods. Moreover, the imaging genetics approach extends the information delivered by neuroimaging methods. Future studies will show whether such multimodal neuroimaging approaches will help to improve diagnostic procedures and treatment decisions in ADHD.

HT-07-02 Neurochemical ndings using MR spectroscopy. Similarities and differences in childhood and adult ADHD E. Perlov* * Freiburg im Breisgau, Germany Objective: Neurobiological research has implicated the striatum and basal ganglia as crucial in the pathophysiology of ADHD. These regions are dense connected with the cortex of the frontal brain, in particular with the anterior cingulated cortex (ACC) and some structures of cerebellum. That is a well known fact that the ACC is crucially involved in the regulation of impulse control and emotional regulation. Latest theoretical conceptualizations of the cerebellum as core site of the brain to model motor, affective and cognitive behaviour performed by M. Ito and J. Schmahmann puts weight to the assumption that it might also play a key role in ADHD pathophysiology. Method: In our recent studies we found signicantly increased glutamate-glutamine (Glx) to creatine (Cre) ratios in the left cerebellar hemisphere and decreased ratios of this metabolite in the right ACC using the method of Magnet Resonance Spectroscopy (MRS). In our review and metaanalysis of MRS studies in ADHD we found alterations in choline compounds. Our new study investigates the metabolic disturbances in ACC and cerebellum in adult ADHD in more then 100 patients. The preliminary ndings of this study would be present. Conclusion: The discussion about possible implications of the neurochemical alterations in different brain regions in ADHD is the main issue of the talk. Concerning the cerebellar alterations, this is the rst evidence for alterations in neurochemistry in ADHD. This relate well to recent hypotheses that the cerebellum might control mental activities by internal models.

HT-07-04 Fear acquisition and extinction in adult ADHD: A simultaneous conditioning & fMRI study. Is there a specic pattern of dysfunctional emotional learning in ADHD across the life span? L. Tebartz van Elst*, S. Maier, E. Perlov, O. Tuescher * Freiburg, Germany Objective: Recently there is an increase of awarness towards emotional decits in Attention Decit Hyperactivity Disorder (ADHD). In the present study we aimed to assess whether ADHD patients show abnormalities already at a basic level of explicit and implicit emotion processing. Method: To implement this we conducted a classical fear conditioning (FC) paradigm, as well as a so called instructed fear (IF) study where subjects acquired a fear adaptive response by being told an aversive stimulus might occur when viewing a neutral image. 17 adult ADHD patients and healthy control subjects were studied in an experiment of classical fear conditioning and 13 further adult patients and 17 healthy controls were instructed which visual stimulus might be paired with an aversive electrodermal stimulation (threat condition). In both studies we recorded skin conductance responses (SCR) and functional imaging data (fMRI) in the experimental trials. Results: In the FC study, which aimed to induce fear mainly implicitly, we found no differences between groups. In patients and controls the SCR was signicantly higher for the CS? as compared to the CS- condition, while there was no signicant difference in SCR between groups. In the IF study, which aimed to induce fear cognitively or explicitly, controls showed a very similar activity pattern as described in earlier studies using the same paradigm. As in the FC study skin conductance measurements did not show any signicant group differences and both groups reported they expected an aversive stimulus during the threat condition. In the group comparison contrasting the threat to the safe condition revealed a diminished BOLD response towards the threat condition in the fear expression network in ADHD patients, namely in the dorsal anterior cingulate cortex (dACC) and the bilateral anterior insula.

HT-07-03 Multimodal functional brain imaging in ADHD: Do we have reliable markers of ADHD dysfunction? A. Fallgatter*, A.-C. Ehlis * Tubingen, Germany

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91 Conclusion: The implications of these ndings with respect to emotional information processing in adult ADHD will be discussed. their gains over 6 and 12 months. Improvements in investigator-rated inattentive symptoms from baseline to post-treatment predicted better functioning on the LIFE-RIFT at post-treatment (p = .017) but did not predict impairment scores at 6- or 12-month follow-up. Conclusion: Among adults with persistent ADHD symptoms treated with medication, the use of cognitive-behavioral therapy compared with relaxation with educational support resulted in improved ADHD symptoms which were maintained at 12 months.

Friday, 27 May 2011, 16.0017.30 HT-08 Next steps towards empirically supported psychosocial treatments for adult ADHD
HT-08-01 Treatment of adults with ADHD: CBT only versus medication and CBT L. Hechtman* * Montreal, Canada Objective: To evaluate the relative efcacy of CBT only versus medication and CBT combined for adults with ADHD. Method: Sixty-six adults who met DSM IV criteria for ADHD via Connors Adult ADHD Diagnostic Interview (CAARSD) and who had no current comorbidities that required treatment were randomly assigned to receive either a 12-week group CBT program or medication with CBT combined. The CBT program, with 6-10 subjects per group, addressed organizational and time management skills, anger management and relationships, as well as self esteem and cognitive restructuring issues. Individual coaching calls three times a week were also part of this program. Outcome evaluations included ADHD symptoms and the areas outlined above which were targeted in the CBT program. Results: Generally most subjects completed the 12-week CBT program and all groups beneted from the interventions. However, the combined group seemed to benet most as they were able to make the most use of the CBT program and generalized it best. Conclusion: Adults with ADHD may require both medication and CBT for optimal outcome.

HT-08-03 DBT-based treatment in adult ADHD A. Philipsen*, E. Graf, S. Matthies, M. Colla, C. Jacob, E. Sobanski, B. Alm, M. Roesler, B. Kis, M. Huss, M. Berger * Freiburg, Germany Objective: Adult ADHD is a serious risk factor for co-occurring psychiatric disorders and negative psychosocial consequences. Given this background, instead of or in addition to psychopharmacological treatment, there is a need for effective psychotherapeutic treatment options for adults with ADHD. Method: Due to overlapping clinical features in adult ADHD and borderline personality disorder (BPD) (e.g. emotion dysregulation, impulse control, low self esteem, disturbed interpersonal relationships, Philipsen et al. 2008, 2009) our treatment is mainly based on the principles of dialectical behavioral treatment (DBT, Linehan, 1993). Cognitive behavioral treatment strategies are mainly integrated to modify maladaptive thoughts which interfere with the therapy (homeworks, acquirement of new skills). The structured program is applied in weekly session to adult ADHD outpatients in a group setting. The several topics are presented to the patients in a treatment workbook (Hesslinger et al. 2004). Results: As shown in our pilot study and feasibility multicenter study (Hesslinger et al. 2002, Philipsen et al. 2007), the DBT-based program with 13 weekly sessions resulted in good outcomes. ADHD severity, depression and personal health status were signicantly improved. Patients regarded the program topics behavioural analyses, mindfulness and emotion regulation as the most helpful. As in our initial pilot study, patients in the multicenter study rated the group setting as highly effective. However, so far, randomized placebo-controlled studies comparing the effects of medical management, specic psychotherapy, and the combination of both are still lacking. Therefore, the University of Freiburg, Germany, has initiated a multicenter trial at seven university sites which is funded by the German Federal Ministry of Research and Education (01GV0606, ISRCTN54096201). Conclusion: In the lecture preliminary data of the interim analysis will be presented.

HT-08-02 Comparison of CBT to relaxation with educational support for residual ADHD in adults S. Sprich*, S. Safren, M. Mimiaga, C. Surmann, L. Knouse, M. Groves, M. Otto * Boston, USA Objective: To test cognitive-behavioral therapy (CBT) for ADHD in adults treated with medication and clinically signicant symptoms. Method: 86 medicated adults with clinically signicant ADHD were randomly assigned to receive either CBT or an attention-matched comparison treatment, relaxation with educational support (RES). All participants received 12 individual sessions of either CBT or RES. The primary outcome measures were ADHD symptoms rated by a blinded assessor (ADHD rating scale and Clinical Global Impression Scale (CGI)) at baseline, post-treatment and 6- and 12-month followup. The secondary outcome measures were self-report and investigator report of ADHD symptoms and scores on the Range of Impaired Functioning Tool (LIFE-RIFT). Results: CBT achieved lower post-treatment scores on both the CGI (magnitude -0.0531; 95% condence interval (CI), -1.01 to -0.05; p =.03) and the ADHD rating scale (magnitude -4.631; 95% CI, -8.30 to -0.963, p =.02) compared with RES. Throughout treatment, selfreported symptoms were also signicantly more improved for CBT (beta=-.041; 95% CI, -0.64 to -0.17; p \.001), and there were more treatment responders in CBT for both the CGI (53% vs. 23%; odds ratio (OR), 3.80; 95% CI, 1.50 to 9.59; p =.01) and the ADHD rating scale (67% vs. 33%; OR 4.29; 95% CI, 1.74 to 10.58; p =.002). Responders and partial responders in the CBT condition maintained

HT-08-04 Cognitive-behavioral treatment for adult ADHD: Targeting executive dysfunction M. Solanto*, D. Marks, J. Wasserstein, K. Mitchell, H. Abikoff, J. M. J. Alvir, M. Kofman * New York, USA Objective: The authors examined the efcacy of a 12-week manualized group cognitive-behavioral intervention designed to enhance time-management, organization, and planning in adults with AD/HD. Method: Eighty-eight clinically referred adults who met DSM-IV criteria for ADHD based on clinical and structured diagnostic inter` views and standardized questionnaires were stratied vis-a-vis ADHD medication use and otherwise randomly assigned to receive ADHDspecic cognitive-behavioral therapy (CBT) or supportive

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92 psychotherapy in a group modality. The CBT developed for this intervention employs cognitive-behavioral principles and methods to impart skills and strategies in time-management, organization, and planning, and target depressogenic and anxiogenic cognitions that undermine effective self-management. The Support group controlled for non-specic aspects of treatment by providing support while avoiding discussion of cognitive-behavioral strategies. Therapeutic response was assessed by an independent (blind) evaluator via structured interview pre- and post-treatment, as well as by self-report and collateral informant behavioral ratings. Results: General linear modeling analyses, comparing change from baseline between treatments, revealed statistically signicant effects for independent evaluator, self-report, and collateral ratings of DSMIV inattentive symptoms. Employing dichotomous indices of therapeutic response, a signicantly greater proportion of MCT vs. Support group members demonstrated improvement. Logistic regression examining group differences in operationally dened response (controlling for baseline ADHD severity) revealed a robust effect of Treatment Group (odds ratio=5.41; 95%CI=1.77). Conclusion: CBT (vs. Support) yielded signicantly greater improvements in dimensional and categorical estimates of ADHD severity, supporting its efcacy as a viable psychosocial intervention. three studies we measured the reactivity towards pleasant, neutral and unpleasant pictures and assessed the affect-modulated startle reex and electrodermal responses to indicate valence and arousal perception in children and adults. In a fourth study, we obtained psychometric alexithymia scores. The fth study measured the emotional reactivity assessed with the startle reex towards stimuli which have been conditioned to different delay periods to measure delay aversion in adults. The last study assessed whether incentives and methylphenidate have an impact on attentional control in children using an attention modulated prepulse startle facilitation paradigm. Results: The studies indicated that ADHD adults with the combined type are marked by a reduced reactivity towards pleasant stimuli, and the hyperactive-impulsive type towards pleasant and unpleasant stimuli, while the inattentive subtype reacted comparably to controls. Children with ADHD combined type were marked by reduced arousal reactions towards the emotional stimuli. Methylphenidate normalized emotional dysfunctions in both, ADHD adults and children. In adults with ADHD, hyperactive-impulsive but not inattentive symptoms were associated with elevated alexithymia scores. ADHD adults also showed an aversive reactivity towards delay associated cues, while cues indicating no delay were perceived as pleasant. With respect to attentional control, we found that methylphenidate and incentives both reduced attentional control decits in children with ADHD. Conclusion: Results point to emotional-motivational decits especially in ADHD patients with hyperactive-impulsive symptoms which seem to be normalized by methylphenidate. Motivational factors improve the cognitive performance of children with ADHD.

Friday, 27 May 2011, 16.0017.30 HT-09 KFO 125 ADHD

HT-09-01 Familial investigations in ADHD T. Renner*, M. Romanos, C. Jacob, T. Nguyen, C. Freitag, J. Meyer, H. Schafer, M. Gerlach, K.-P. Lesch, A. Warnke * Wurzburg, Germany Objective: High hereditability underlines the importance of family based approaches in ADHD studies. Clinical and genetic data of the Wurzburg Clinical Research Program ADHD KFO (125) are presented. Method: Clinical modiers were investigated in a sample of ADHD families (n=280). Additionally a sample of multigenerational families was investigated by genome-wide linkage analysis. Results: New genetic loci were indicated by the multigenerational pedigrees linkage analysis. A high rate of comorbidities was detected in the ADHD families. Preliminary data on clinical modiers of ADHD is reported. Conclusion: Linkage analysis detected several genomic loci, indicating new candidate genes. A developmental course of comorbidities in ADHD is suggested. Pathophysiological overlaps between ADHD and comorbities will be elucidated in further studies.

HT-09-03 Imaging genetics in ADHD - neurophysiological endophenotypes A.-C. Ehlis*, T. Dresler, S. Heinzel, T. Renner, K.-P. Lesch, A. Fallgatter * Tubingen, Germany Objective: ADHD is one of the most common psychiatric disorders in childhood, which in many cases persists into adulthood. Several etiological factors have been discussed, with genetic factors playing a pivotal role. In order to identify not only potential risk genes for ADHD, but also the specic mechanisms by which genetic variants might contribute to the disease, candidate polymorphisms need to be related to specic behavioral, cognitive or neurophysiological phenotypes. These so-called endophenotypes are considered to be more directly connected to the relevant underlying psycho- or neuropathology and thereby etiological factors than the clinical diagnoses themselves. Promising endophenotypes for ADHD include executive functions such as inhibitory control, working memory and higher order controlled motor functioning. Scientic approaches attempting to connect neural correlates of these endophenotypes to genetic risk variants have been subsumed under the topic of imaging genetics or genomic imaging. Method: The present talk will give an overview of the genomic imaging ndings obtained in the KFO 125 sample of adult ADHD patients. Specically, over the past years, we have examined processes of response inhibition and prefrontal response control in adult ADHD patients as well as healthy control participants in order to relate neurophysiological markers to potential risk polymorphisms of the disease. Results: We report several interactions between diagnostic categories and genetic subgroups, including a few gene-gene interactions, specically focussing on polymorphisms affecting dopaminergic (DAT1, DRD4, COMT) and serotonergic (TPH2, 5-HTTLPR) neurotransmission. The results indicate an impact of ADHD risk genes on neurophysiological measures of prefrontal functioning with partly differential effects in both diagnostic groups (ADHD patients vs. healthy controls).

HT-09-02 Emotional-motivational decits in ADHD A. Conzelmann*, R. Mucha, C. P. Jacob, P. Weyers, A. J. Fallgatter, M. Romanos, A. Warnke, K.-P. Lesch, P. Pauli * Wurzburg, Germany Objective: We wanted to investigate whether emotional-motivational reactivity of ADHD patients is disturbed in terms of subjective and psychophysiological reactions, whether methylphenidate has an impact on emotional-motivational reactivity and whether motivational factors improve cognitive dysfunctions in ADHD patients. Method: We assessed samples of adults and children with and without ADHD. Some patient groups were medicated with methylphenidate. In

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93 Conclusion: We conclude that studies on endophenotypes in ADHD are valuable research strategies suited to further elucidate the mechanisms by which genetic risk factors might contribute to the eventual clinical phenotype of the disease. other core symptoms of ADHD, indicating that mood instability might also represent a core symptom of ADHD. Method: Using a sample 50 untreated adults with ADHD and 50 controls, we investigate the correlation between ADHD and mood instability and the co-variation of these two sets of symptoms over time. Results: Our preliminary analyses are promising in showing very high correlations, in the order of 0.8, between both inattentive and hyperactive-impulsive symptoms and mood instability. Further, we have validated our ndings using rating scales with real time experience sampling in which we measure the variability in mood symptoms measure over the working week. Conclusion: We conclude that ADHD and mood instability symptoms in adults are closely linked. Further work is needed to delineate whether the close relationship arises from shared aetiological factors. Initial analyses using the sample presented here will investigate the co-variation during the treatment response with stimulants or other medications for ADHD. Further work is aimed to clarify whether the problems with regulation of emotional responses and mood states seen in ADHD arise from the same underlying processes that lead to impaired regulation of attention and impulse control.

HT-09-04 Genome-wide screening approaches: Towards identication of pathogenetic mechanisms K.-P. Lesch* * Wurzburg, Germany Abstract: Although the substantial heritability of Attention Decit Hyperactivity Disorder (ADHD) is documented in numerous family, twin and adoption studies, with estimates up to 80%, linkage scans followed up by positional ne-mapping, genome-wide association (GWA), and copy number variation (CNV) studies have linked only a few putative risk genes to ADHD. Comparison between population and family-based studies shows little concordance, since loci linked to increased ADHDrisk are often characterized by pedigree-specicity. The origins of common and rare risk alleles are based on population growth and migrations. The oldest alleles are common in all populations worldwide, and account for90% of the variability in allele frequencies. Rapid population growth has led to the appearance of vast numbers of new risk alleles, each individually rare and specic to one population or even to one family. Theserisk genes code for proteins involved in proliferation, migration, and specication of neurons (NPAS3, NRXN1, LPHN3), neurite outgrowth and axonal guidance (e.g., CDH13, ASTN2), intracellular signal transduction (e.g., DIRAS2, NOS1, CTNNA2), and regulators of cellular energy balance (e.g., NPY, SLC2A3). Moreover, it is becoming increasingly evident that epigenetic processestranslating environmental stimuli into changes in expression of established and novel candidate genes play a pivotal role in establishing long-lasting changes in brain function related to ADHD.Work in progress now focusses on the elucidation of the role of these new candidates in the pathogenesis of ADHD using neuronal cell models, genetically modied animals, such as mouse and zebrash as well as neuropsychological and imaging paradigms in humans. Preliminary evidence from these studies suggests that several pathogenetic pathways converge on ADHD-associated dysregulation of monoaminergic signalling.

HT-10-02 Emotional symptoms in children and adolescents with ADHD T. Banaschewski* * Mannheim, Germany Objective: ADHD is often associated with symptoms of emotional lability (EL), such as irritability, hot temper, low frustration tolerance, and sudden unpredictable shifts towards negative emotions such as anger, dysphoria and sadness. EL has been consistently noted in the changing denitions of the ADHD construct and its diagnosis and is currently considered an associated feature of the disorder. However, it is still unclear how EL and ADHD are interconnected. Method: 1186 children with ADHD-combined type and 1827 siblings (aged 6-18 years) were assessed for symptoms of EL, ADHD, associated psychopathology and comorbid psychiatric disorders with a structured diagnostic interview as well as parent and teacher ratings of psychopathology. Analyses of variance, regression analyses, v2-tests or loglinear models were applied. Results: Age, hyperactive-impulsive, oppositional, and emotional symptoms accounted for 30% of EL variance; hyperactive-impulsive symptoms did not account for EL variance when coexisting oppositional and emotional problems were taken into account, but oppositional symptoms explained 12% of EL variance specically. Severity of EL in probands increased the severity of EL in siblings, but not the prevalence rates of ADHD or ODD. EL and ADHD does not co-segregate within families. Conclusion: EL is a frequent clinical problem in children with ADHD. It is associated with increased severity of ADHD core symptoms and more symptoms of comorbid psychopathology, primarily symptoms of oppositional deant disorder, but also affective symptoms, and substance abuse. EL in ADHD seems to be more closely related to ODD than to ADHD core symptoms, and is only partly explainable by the severity of ADHD core symptoms and associated psychopathology. Although EL symptoms are transmitted within families, EL in children with ADHD does not increase the risk of ADHD and ODD in their siblings.

Friday, 27 May 2011, 16.0017.30 HT-10 Emotional symptoms in ADHD: Part of the disorder?
HT-10-01 Mood variability in adults with ADHD P. Asherson*, C. Skirrow, J. Kuntsi, G. McLoughlin * London, United Kingdom Objective: ADHD is a neurodevelopmental disorder that persists into adulthood in two-thirds of cases. Current denitions of ADHD focus on three core domains of inattention, overactivity and impulsivity, yet it is widely recognised that there is a wider range of co-occurring psychopathology. Among the most prevalent of these is mood instability, characterized by shifts in mood from highs to lows, frustration, and chronic irritability. Mood instability may often be the main presenting symptom of ADHD and may also be one of the more impairing features of the disorder. Importantly, it has been noted that treatment for ADHD with stimulants or atomoxetine often results in improvements in mood instability symptoms in the same timescale as

HT-10-03 The concept of emotional symptoms as dened by the Utah criteria of ADHD F. Reimherr*, M. K. Marchant, J. L. Olsen, R. J. Robison * Salt Lake City (UT), USA

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94 Abstract: Previous studies have documented that many patients with Attention Decit Hyperactivity Disorder (ADHD) have signicant emotional symptoms. Such symptoms are part of the Utah Criteria for the diagnosis of ADHD in adults and are assessed by the WenderReimherr Adult Attention Decit Disorder Scale (WRAADDS). Following previously published criteria, scores showing an average of moderate impairment or worse on the WRAADDS emotional factor items assessing temper, mood lability, and emotional overreactivity were used to categorize patients with emotional dysregulation. These symptoms help to characterize the more complex presentation of adults with ADHD. Data from 2 highly positive placebo-controlled, crossover studies examining methylphenidate were combined (N = 136). 72% met criteria for emotional dysregulation. These patients were more likely to have combined-type ADHD, more oppositional deant symptoms, higher ADHD ratings, worse social adjustment, higher personality disorder ratings, and a trend toward more substance abuse. Both groups responded to methylphenidate. Emotional symptoms in subjects with emotional dysregulation also showed a very signicant response (effect size = 0.83). A large portion of adults with ADHD in this sample showed symptoms of emotional dysregulation. These results including high levels of the emotional dysregulation in the sample, association of emotional dysregulation with more severe, complex symptoms at baseline and signicant treatment response of emotional dysregulation symptoms to methylphenidate] support including emotional dysregulation as a core feature of more severe adult ADHD. Adults with ADHD and emotional dysregulation should be viewed as a distinct subgroup.

Friday, 27 May 2011, 16.0017.30 HT-11 International ADHD treatment guidelines for childhood, adolescence and adulthood
HT-11-01 Guidelines in Francophone and Eastern European countries B. Millet* * Rennes, France Abstract: Many controversies exist in France regarding diagnosis and treatment of ADHD. Even though the realty of the disorder is now considered for children and young adults, the clinical picture in adult remains blurred and needs clarication with other disorders especially bipolar disorders. The prevalence of ADHD in France would range from 3.5% to 5.6% for youth and from 4 to 5% into adulthood. Adults with ADHD seem to have high rates of comorbid Axis I and II disorders Treatment as in other countries is based on psychotherapeutical approaches especially behavioral and cognitive therapy at rs line and pharmaceutical treatments with psychostimulants, and to a lesser extent antidepressants. A synthesis of the literature by French authors will be provided during this session.

HT-11-02 Guidelines in Mediterranean and Latin countries, Asia and Africa J. A. Ramos-Quiroga* * Barcelona, Spain

HT-10-04 Different psychopathological dimensions in adult ADHD R.-D. Stieglitz*, M. Rosler * Basel, Switzerland Objective: The diagnosis of Attention Decit Hyperactivity Disorder (ADHD), as described in DSM-IV, requires on the psychopathological level 6 or more symptoms of inattention and/or 6 or more symptoms of hyperactivity/impulsivity. Based on these syndromes 3 diagnostic subtypes were identied (ADHD-combined type, ADHD-predominantly inattentive type, ADHD predominantly hyperactive-impulsive type). The DSM-IV symptoms and the subtypes were originally developed for the use in child psychiatry. The question remains whether the DSM-IV criteria are adequate to characterize adult ADHD. Several authors (e.g. Wender) propose that the picture of the disorder is more differentiated in adults than in children. One issue, which is often discussed, concerns the signicance of emotional dysregulation. Emotional dysregulation is not only a potential further aspect of ADHD in adults but also a problem to distinguish ADHD from other psychiatric disorders (e.g. borderline personality disorder). A further aspect of the psychopathology of adult ADHD is disorganization. This domain of symptoms is related to disturbances of executive functioning, which is reported to be impaired in ADHD. Method: This is a review of the literature regarding the different symptom domains of adult ADHD. In addition the authors report on their own investigations in this eld of research including more than 1.000 persons suffering from ADHD. Results: Beside the classical psychopathology of adult ADHD (inattention, hyperactivity, impulsivity) emotional dysregulation and disorganization are frequently part of the clinical picture. The factor structure of this model of adult ADHD will be discussed. Conclusion: Symptoms of emotional dysregulation and disorganization seem to be intrinsic factors of the psychopathology of adult ADHD. The diagnostic criteria for the use in adults should incorporate those symptoms.

Objective: To review the recommendations of the available Guidelines for ADHD across life span of these geographic areas. Method: Systematic qualitative revision of the published guidelines for ADHD. Results: At these geographic areas there are guidelines that can be useful to improve the management of ADHD. Methylphenidate are the most recommended rst line drug and atomoxetine is the second. Conclusion: Methylphenidate is the rst line agent and atomoxetine can be the rst option depending of the clinical characteristics of the patient. There is a need for guidelines for adults with ADHD.

HT-11-03 Guidelines in Nordic and German-speaking countries R. Wandschneider* * Rostock, Germany Objective: The health care systems in Nordic and German-speaking countries stand for a high level of quality but are also characterised by a multitude of different scopes, emphases and approaches. This is reected in a plethora of different ADHD guidelines. The aim of our study was to research and compare the available national and international guidelines in these regions. Method: Therapeutic guidelines of different origin national and international medical associations, health care providers, governmental bodies as well as summaries of product characteristics (SPCs) were analyzed and compared with regard to their congruences and dissimilarities. Results: We discovered both a large number of different guidelines as well as a signicant inhomogeneity between them. Conclusion: It would be desirable if more unifying, consensual and independent guidelines could be produced. This would increase general acceptability, protect diagnostic and therapeutic freedom and be in the best interest of our patients and their families.

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95 HT-11-04 ADHD guidelines in Anglophone countries J. Thome* * Rostock, Germany Objective: Several guidelines for the diagnosis and treatment of ADHD both in childhood and adulthood have been published in the English-speaking world. This paper aims at presenting the main aspects of some selected guidelines and to compare them with each other for similarities and differences. Method: The following guidelines were selected: the CADDRA Canadian ADHD Practice Guidelines, the UK NICE guideline, the Australian Guidelines on ADHD and the US ACAAP/APA guidelines. Results: While there are many similarities between the different guidelines, there still remain several differences, especially regarding the different age groups (i.e. child/adolescent and adult) and the relevance of pharmacological and non-pharmacological treatment strategies. Conclusion: Further convergence of the different guidelines based on scientic and clinical evidence would be desirable, as well as continuous updating in order to integrate newly available research results. Nevertheless, national specics such as the organisation of health care and service delivery must be considered. Ultimately, the global exchange of information and ideas should lead to an improved and reliable standard in diagnosing and treating patients suffering from ADHD. Objective: Attention Decit Hyperactivity Disorder (ADHD) is one of the most common child psychiatric disorders. Previous studies have reported a blunted cortisol response to challenging situations and a decreased cortisol awakening response (CAR) in children with ADHD. As ADHD often is comorbid with oppositional deant disorder (ODD), conduct disorder (CD), or anxiety disorder (AnxD), and changes in hypothalamic-pituitary-adrenal (HPA) axis activity have also been reported for these disorders, the present study aimed to compare the CAR in children with ADHD with and without comorbid disorders. Method: Data on the CAR were obtained in 128 children with ADHD (aged 6-13 years) and in 96 control children (aged 6-12 years). Results: Children with ADHD?ODD showed an attenuated CAR (area under the curve, AUC) compared to children with ADHD without ODD/CD and control children. Conclusion: Findings point towards either disinhibition or pervasive underarousal in children with ADHD?ODD, and seem to be specic for children with ADHD?ODD, as the attenuated CAR-AUC was not observed in children with ADHD without comorbid disorders or children with ADHD?CD or ADHD?AnxD. In addition, current adverse parenting conditions, family conicts, and acute life events were associated with mean increase in CAR, emphasizing the role of psychosocial risk factors in mediating HPA axis activity in children with ADHD.

HT-12-03 Genome-wide association analysis of conduct disorder in an ADHD background

Friday, 27 May 2011, 16.0017.30 HT-12 ADHD and conduct disorder from childhood to adulthood
HT-12-01 Co-morbid disorders of childhood ADHD M. Romanos*, T. Renner, R. Taurines * Munchen, Germany Objective: Comorbid disorders in ADHD are highly prevalent yet variable throughout life thus resulting in substantial difculties in regard to clinical diagnosis, scientic categorization, and etiological conceptualization. Method: Referring to conduct disorder as example theoretical models of comorbidity are discussed. Recent clinical and epidemiological approaches to elucidate the complexity of comorbidity in ADHD are presented. Results: The phenotypic complexity and temporal characteristics of co-morbidity mirror the heterogeneous multifactorial aetiology of ADHD. Recent data suggest that both psychiatric and non-psychiatric co-morbidity need to be considered. Conclusion: Heterogeneity of ADHD impedes rather aetiologically based clinical classication systems of ADHD. Future research on ADHD with improved approaches to account for co-morbid disorders will hopefully result in enhanced concepts for clinical differentiation.

R. Anney* * Dublin, Ireland Objective: Individuals with Attention Decit Hyperactivity Disorder show high co-morbidity with a wide range of psychiatric disorders including oppositional deant disorder (ODD), conduct disorder (CD), anxiety disorder, depression, substance abuse and pervasive developmental disorder (PDD). Family studies suggest that ADHD?CD represents a specic subtype of the ADHD disorder with familial risk factors only partly overlapping with those of ADHD alone. As part of a series of exploratory analyses of the GAIN-ADHD sample we attempted to identify markers and genes important in the development of conduct problems in this European cohort. Method: Over 900 affected proband-parent trios from the International Multicenter ADHD Genetics (IMAGE) project were initially selected for the GWAS scan. Four broad phenotypic measures of conduct problems (CP) for the ADHD probands were described. First a categorical measure of CP was dened using DSM IV criteria of CD. Three additional quantitative measures of CP were dened using the Parent Account of Childhood Symptoms (PACS), the Long Version of the Conners Parent Rating Scale (CPRS-R:L) and a combination of the two. Logistic and linear regression for the categorical and quantitative traits respectively were performed using PLINK v1.07. Associations were adjusted for gender and population metrics. Results: None of the analyses found markers showing genome-wide statistical signicance. Eleven loci that show modest association signal (P\10e-6) were observed across the four analyses. Conclusion: Determination of whether these ndings represent the identication of putative risk variants and genes requires additional replication in an independent study. We discuss these ndings in the context of association enrichment, putative candidate genes and their implications to our understanding of the etiology of ADHD?CP. This work is part of an ongoing collaboration for the International Multicentre ADHD Genetics project.

HT-12-02 Cortisol awakening response in children with ADHD with and without oppositional deant disorder or conduct disorder C. Freitag*, S. Hanig, H. Palmason, J. Meyer, S. Wust, C. Seitz * Frankfurt, Germany

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96 HT-12-04 Co-occuring problems of early onset persistent, childhood limited, and adolescent onset conduct problem youth E. Barker* * United Kingdom Abstract not received HT-13-04 Effects of omega 3/6 dietary supplements in ADHD M. Johnson* * Goteborg, Sweden Objective: Review of studies with omega 3/6 fatty acids in the treatment of Attention Decit Hyperactivity Disorder (ADHD) in children and adolescents. Method: Comparison of results from randomized placebo-controlled trials including our own recent study of Omega 3/6 fatty acid treatment for 6 months in 75 children and adolescents with clinically diagnosed ADHD Results: Studies show varying but signicant improvements. Our own study indicated that treatment responders tended to have ADHD inattentive subtype and comorbid neurodevelopmental disorders. Conclusion: A subgroup of children and adolescents with ADHD, characterized by inattention and associated neurodevelopmental disorders, treated with Omega 3/6 fatty acids, responded with meaningful reduction of ADHD symptoms.

Saturday, 28 May 2011, 16.0017.30 HT-13 Non-pharmacologic interventions for the treatment of ADHD
HT-13-01 Dietry interventions on ADHD J. Buitelaar* * Nijmegen, The Netherlands Abstract not received

Saturday, 28 May 2011, 16.0017.30 HT-14 Impact of ADHD on the risk for delinquent behaviour
HT-14-01 Adult ADHD and pathological gambling W. Retz*, J. Ringling, M. Vogelgesang, M. Rosler * Homburg, Germany

HT-13-02 Effects of family based interventions M. Dopfner* * Koln, Germany Abstract not received

HT-13-03 Effects of school based intervention M. Danckaerts* * Belgium Objective: The objective of this contribution is to provide an overview of the different types of school-based interventions aimed at improving ADHD and its concomitant functional impairment within the school environment. Method: A systematic search of the literature has been undertaken to identify relevant meta-analytic and review papers, as well as studies reporting effect sizes on outcomes such as ADHD-related behaviour, compliance with school-based rules and homework and/or academic performance. Both behavioural interventions and interventions aiming at manipulating academic instruction and material have been searched for. Results: A wide variety of different interventions for children with ADHD is described in the school setting. However, for most of these, no controlled studies exist. Mainly contingency based management interventions have been studied more thoroughly, but often in intensive programs and special school settings, limiting the relevance to naturalistic classroom situations. Effect sized reported are typically in the same range as for parent training and smaller than for medication. Conclusion: Behavioural interventions both at home and in the school are deemed important in the treatment of ADHD according to current European Guidelines. A wide variety of interventions is described in the literature, but high quality studies in representative school environments are still lacking. Nevertheless creative ideas and interesting programs are identied, which hopefully can be studied more rigorously in the near future in order to evaluate their potential for improving outcome in children with ADHD.

Objective: Pathological gambling (PG) refers to the uncontrollable impulse to gamble, irrespective of the interference the behavior has on the individuals life. It often results in nancial problems; disrupted relationships, and criminal behavior. PG is frequently associated with psychiatric axis-I and II disorders. Also ADHD is related to PG and delinquent behavior. Method: Thus, we performed a study with 161 PG patients to explore the relationship between PG, ADHD and delinquency. All individuals were diagnosed for axis-I and personality disorders according to ICD10. For the diagnostic process of PG and ADHD also standardized instruments were used. Results: In the study population we found an ADHD lifetime prevalence of 29.2%, 24.2% fullled the DSM-IV criteria for the full ADHD syndrome. In PG patients with ADHD a higher prevalence of further psychiatric disorders was found as compared to PG patients without ADHD. These included substance use disorders and personality disorders. Moreover, higher ratings on the SCL-90 hostility scale were found. PG patients reported more lifetime convictions, a lower age of rst conviction, and there was a trend for more violent offences than in PG patients without ADHD. Conclusion: ADHD seems to be a risk factor for the development of pathological gambling and there is evidence that lifetime and persisting ADHD modulates the risk for delinquent behavior in adult pathological gamblers.

HT-14-02 Impact of ADHD on behavior disorders in prison inmates G. Gudjonsson* * London, United Kingdom

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97 Objective: Recent research has focused on identifying factors that predict critical incidents and behavioural disturbance in institutional settings. The ndings from three different studies are reviewed and presented. These include adolescents in a secure unit facility, adults with a primary diagnosis of Personality Disorder detained in secure unit services, and prisoners serving sentences for a variety of offences. In all three studies, participants were assessed for ADHD symptoms. The studies showed that ADHD was a signicant predictor of behavioural disturbance/critical incidents within each institution, and it was found that ADHD symptoms predicted behavioural disturbance/critical incidents above and beyond that of Conduct Disorder in adolescents and Personality Disorder traits in adults. The ndings point to the unique contribution of ADHD symptoms as a risk factor for behavioural disturbance/critical incidents within correctional institutions. Objective: The majority of the adults with ADHD have chronic difculty to go to bed on time. This leads to a shorter sleep duration and daytime sleepiness that may aggravate the inattention problems of ADHD. This sleep pattern is also known as a delayed sleepphase, and the patients as eveningtypes. The other way round, eveningtypes have been associated with impulsiveness. Method: Review of the literature in child and adult ADHD regarding sleep, and presentation of research in 40 adults on sleeppatterns using questionnaires, measurements of Dim Light Melatonin Onset and actigraphy, compared to controls. Results: The adults with ADHD display a chronic delayed sleep phase pattern in about 80%. Dim Light Melatonin Onset is signicantly delayed in those with sleep onset problems compared to those without, and to normal controls. In addition, the activity pattern as shown by actigraphy is delayed as well. Conclusion: In this presentation the impact of this sleep pattern in adults with ADHD on mood (i.e. seasonal affective disorder), eating habits (like timing of meals and binge eating), activity patterns (like nightshift work and light at night) and health in general, i.e. obesity and cancer will be discussed. Reference: van Veen MM, Kooij JJS, Boonstra AM, Gordijn MCM, van Someren EJW. Delayed Circadian Rhythm in Adults with Attention Decit Hyperactivity Disorder and Chronic Sleep-Onset Insomnia. Biol Psych 2010,67(11):1091-6.

HT-14-03 ADHD modulates the risk for reactive violence M. Rosler*, W. Retz * Homburg, Germany Objective: The prevalence of ADHD in offender populations is increased. But the risk to develop criminality is mainly caused by comorbid conduct disorder and not by ADHD. We conducted a study on different offender populations to answer the question whether ADHD may have a modulating effect on the type of violent offences. Method: We performed a case control study with violent and nonviolent offenders. The violent offenders were classied according to the typology as dened by the rules of the penal code. Furthermore the violent offences were devided according to the concept of proactive and reactive violence. Results: When we compared non-violent and violent offenders with regard to the prevalence of ADHD we found no differences between the two groups. The analysis of the prevalence of ADHD in different violent offender groups (sexual violence, murder, assault, etc.) revealed again no differences. When we grouped the persons according to the reactive/proactive model we found a massive overrepresentation of individuals with ADHD among the reactive violence group. Conclusion: We favour the hypothesis that ADHD has a modulating effect on the type of violent offences. There is a signicant preponderance of offenders with ADHD among the group of reactive violent offences.

HT-15-02 Impact of ADHD medication on circadian rhythms and clock gene expression A. Coogan*, A. Baird, S. OKeeffe, M. Barrot, J. Thome * Ireland Objective: The aim of this study was to examine the effects of methylphenidate and atomoxetine on circadian clock gene product expression in the mouse brain, as well as examining the effects on behavioural circadian rhythms. Method: We examined the effect of 7 days treatment with methylphenidate (2.5 mg/kg, i.p.), atomoxetine (3 mg/kg, i.p.) or saline on PER1, PER2, CLOCK and c-Fos expression, by means of semiquantitative immunohistochemistry in a number of regions of the mouse brain, including the master suprachiasmatic nucleus circadian clock. We also examined the effects of acute treatment with atomoxetine (3 mg/kg), under varying photic conditions and at different points in the circadian cycle, on behavioural circadian rhythms in mice, as well as on PER2, CLOCK, BMAL1 and c-Fos expression in the mouse brain. Results: Chronic treatments with methylphenidate or atomoxetine altered diurnal patterns of expression of clock gene products in a number of hypothalamic, basal ganglia, cortical and subcortical regions. Regions affected include the suprachiasmatic nucleus, the hippocampus and the striatum. In another set of experiments it was found that acute treatments with atomoxetine altered behavioural circadian rhythms in mice in a phase-dependent manner. We found that atomoxetine treatment during the circadian day against a photic background of constant light produced a phase-delay of *3 h, whilst treatments during the night phase did not elicit signicant alteration. Atomoxetine treatment also altered expression of clock gene products in the master circadian suprachiasmatic clock. The effects of atomoxteine were mimicked by treatment with another nor-adrenaline reuptake inhibitor reboxetine, and were blocked by pre-treatment with the alpha-receptor antagonist prazosin. Conclusion: We conclude that these preclinical studies indicate strong evidence that medication used in the management of ADHD can exert profound effects on the circadian timing system

HT-14-04 Does childhood treatment of ADHD decline the risk for adult antisocial behaviour H. Soderstrom* (invited) * Sweden Abstract not received

Saturday, 28 May 2011, 16.0017.30 HT-15 Circadian rhythmicity in ADHD patients through life time
HT-15-01 Changes of circadian behaviour in ADHD patients S. Kooij* * Den Haag, The Netherlands

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98 HT-15-03 Insomnia and morning/evening preference among ADHD patients compared to healthy individuals and other patients with psychiatric disorders B. I. Voinescu*, A. Szentagotai, A. Dobrean * Cluj-Napoca, Romania Objective: Our previous research revealed that chronic insomnia was found in up to 16% of the volunteered healthy individuals and in more than half of the psychiatric patients included in the study (suffering from depression and/or alcoholic abuse/dependence); eveningness was far more frequently found among depressed and alcoholic patients, too. Based on the data in literature, we concluded that subjective sleep complaints were usual ndings in adults diagnosed with ADHD as they experienced daytime sleepiness more often and reported more sleep problems than controls. Non-medicated patients showed associations with self-reported shorter sleep duration, lower sleep efciency, and lower overall sleep quality. Adult ADHD patients also appeared to be more evening oriented. With these in mind and with almost no adult ADHD diagnosis conrmed in Romania, we started a pilot study trying to see whether chronic insomniacs were masking undiagnosed adult ADHD patients. We are using several sleep scales and the Barkley Adult ADHD Rating ScaleIV, as well as combined actigraphic and ambulatory EEG monitoring. Preliminary results are to be presented. improves cognitive functions by modulating task related deactivations (TRDs) in a dened network know as the default mode network (DMN). The effects of atomoxetine (ATX), which has similar afnity for the noradrenaline transporter, but minimal afnity for the dopamine transporter, on these networks is only beginning to be understood. The aim of this study was to use pattern recognition to characterise the differential effects of these drugs in healthy volunteers on brain function. Method: Fifteen healthy male volunteers were scanned after administration of MPH (30mg), ATX (60mg) or placebo on three separate occasions in a latin-square study design. We used continuous arterial spin labelling (cASL) to quantify regional cerebral blood ow (rCBF) and a rewarded working memory (WM) task during BOLD fMRI scanning. Imaging data were preprocessed in SPM5. We used multivariate pattern recognition to characterise the effects of MPH, ATX and placebo using sparse multinomial logistic regression for rCBF and Gaussian process classiers for the working memory task. Results: MPH and ATX rCBF maps could be discriminated accurately (100% and 93% respectively) with a network of changes including increased rCBF in nodes of the DMN, the striatum and substantia nigra (MPH), and decreased rCBF in the brain stem and thalamus (ATX). During rewarded trials both drugs attenuated WM networks and enhanced TRDs in regions consistent with the DMN. Conclusion: Baseline effects of MPH and ATX can be detected in distinct patterns associated with each drug using cASL, although only MPH showed effects in DMN areas. During the WM task both MPH and ATX showing prominent effects during rewarded trials in both task activated and deactivated networks. Thus, interactions between drug effects and motivational state are relevant in dening the functional effects of MPH and ATX, which extended beyond the DMN.

HT-15-04 CLOCK genes polymorphisms and alterations of CLOCK gene expression in ADHD patients J. Thome* * Rostock, Germany Objective: A disturbed circadian rhythm is a typical clinical feature in patients with ADHD. The aim of this study was to establish whether this clinical phenomenology is associated with changes on the molecular level, i.e. with alterations of the expression of so-called CLOCK genes. Method: Buccal swabs were collected from patients and controls in order to obtain cells from which RNA was extracted. Using RT-PCR, expression levels of PER1, PER2 and BMAL1 were quantied at several time points during a 24h period. Results: The rhythmicity of the BMAL1 expression pattern was signicantly changed in patients. Conclusion: To our knowledge, this is the rst study showing a signicant alteration in the expression pattern of CLOCK genes in adult ADHD patients. This could be one of the cellular and molecular mechanisms underlying the changes in circadian rhythmicity observed in clinical practice.

HT-16-02 Head to head comparison of single dose effects of methylphenidate and atomoxetine in fMRI of ADHD children K. Rubia*, A. Cubillo, A. Smith, N. Barret, V. Giampietro * London, United Kingdom Objective: The stimulant drug methylphenidate (MPH) and the nonstimulant drug atomoxetine (ATX) are widely used for ADHD treatment, but their differential effects on ADHD brain function are not known. MPH normalise frontal, striatal and cerebellar brain activation in ADHD children during inhibition, sustained attention and time discrimination (Rubia et al., 2009a,b,2011). However, to our knowledge, no fMRI study has investigated the effects of an acute dose of ATX on brain activation in ADHD, or compared its effects with those of MPH. Method: 20 medication-nave children with ADHD performed 4 tasks in fMRI (3T) after a single clinical dose of MPH, ATX or placebo, in a double-blind, randomized crossover design: a Stop task, a time discrimination task (TD) a parametrically modied sustained attention task (SAT) contrasted with sensorimotor timing, and a visual N-back working memory (WM) task. Repeated-measures ANOVAs were conducted on brain activation and performance with drug condition (MPH, ATX, placebo) as within-subjects factor. Results: Preliminary results (17 patients) show that MPH compared to placebo and ATX improved time estimation, both drugs improved reaction times and response variability in the SAT, but had not effect on WM or Stop task performance. During the Stop task, only ATX enhanced activation in the inferior prefrontal cortex during inhibition, while MPH had drug-specic upregulation effects on striatum and SMA during response execution. During the SAT, ATX and placebo

Saturday, 28 May 2011, 16.0017.30 HT-16 Pharmacoimaging in ADHD

HT-16-01 M. A. Mehta*, A. Marquand, S. de Simoni, O. ODaly, F. Zelaya, S. Williams * London, United Kingdom Objective: Studies in ADHD suggest that methylphenidate (MPH)

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99 showed larger activation than MPH in the temporo-parietal junction during sustained attention, while MPH enhanced activation in this region during sensorimotor timing. During the TD, MPH enhanced anterior cingulate activation compared to placebo and ATX. During the WM task, ATX showed a drug-specic upregulating effect compared to both placebo and MPH on cerebellar and superior temporal activation. Conclusion: The ndings show that ATX and MPH have dissociated and task-dependent drug-specic effects on the brain activation of ADHD children. Objective: To characterize motor cortex inhibition as a biomarker of ADHD diagnosis, symptom severity, and medication response. Method: We have used single and paired pulse Transcranial Magnetic Stimulation (TMS) in our laboratory to study short interval cortical inhbition (SICI) as it relates to ADHD and Tourette Syndrome. The relationship between SICI, a quantitative measure, and ADHD symptom severity as well as acute and chronic treatments have been evaluated. In addition, we present pilot data related to dopamine transporter polymorphisms, and to acute and chronic treatment with methylphenidate and atomoxetine. Results: SICI is reduced by approximately 40% in 8-12 year old ADHD children. This reduction generally correlates (r = .5; p \ .01) with ADHD symptom severity in children with both ADHD and Tourette Syndrome. Medication effects are complex but generally acute treatment, particularly with psychostimulants, tends to normalize SICI in ADHD children. Conclusion: SICI in motor cortex appears to be a biomarker of ADHD symptoms in childhood.

HT-16-03 Head to head comparison of 6 weeks treatment effects of methylphenidate and atomoxetine in fMRI of ADHD children J. Newcorn*, K. Schulz, A.-C. Bedard, J. Fan * New York, USA Objective: The increasing number of FDA-approved stimulant and non-stimulant medications for Attention Decit Hyperactivity Disorder (ADHD) raises important questions about the mechanisms by which different medication classes exert their therapeutic effects. We used event-related functional magnetic resonance imaging (fMRI) to compare the relationship between symptomatic improvement and changes in neural activity produced by six to eight weeks of treatment with methylphenidate versus atomoxetine in youth with ADHD. Method: Youth (n = 16 per group; mean age 11.4 2.8 years; 26 males) were scanned at baseline and after treatment while performing a go/nogo task. Mean medication doses were 55 17 mg for methylphenidate and 1.3 0.5 mg/kg for atomoxetine. The neural origins of the symptomatic improvement were investigated with a general linear model (GLM) analysis that combined within-subjects modeling of pre- versus post-treatment effects and between-group comparisons of these treatment effects. Results: Both medications produced substantial improvement in ADHD symptoms and go/nogo indices, with no signicant differences between the two treatments. Treatment with atomoxetine was associated with signicantly greater increases in activation than methylphenidate in frontostriatal regions. Conversely, there were signicant reductions in medial superior frontal and left posterior cingulate activation with methylphenidate. Symptomatic improvement was related to common activation in medial prefrontal cortex (mPFC), and divergent patterns of activation in right inferior frontal gyrus, left anterior cingulate cortex, left caudate nucleus, bilateral precuneus and right posterior cingulate. Conclusion: Acute treatment with methylphenidate and atomoxetine produced clinical improvement via both common and unique mechanisms, with distinctions seen in several regions within the task positive frontostriatal and task negative cingulate-precuneus networks. These ndings offer a window into the neurophysiological basis of common and unique mechanisms of response to stimulant and non-stimulant treatments, which constitutes an important rst step in matching treatments to individual patients with ADHD.

Friday, 27 May 2011, 16.0017.30 YS-01 Young Scientist Award Session I

YS-01-01 Different executive function proles in children and adolescents with subtypes of ADHD E. W. Skogli*, M. G. ie * Lillehammer, Norway Objective: Subjects with different subtypes of Attention Decit Hyperactivity Disorder (ADHD) often have impaired executive functioning (EF). In terms of the degree and type of impairments, however, the ndings are inconsistent. Research to date has focused mainly on performance-based EF, whereas studies dealing with emotional regulation and EF in naturalistic settings have been largely absent. In the current study, EF in different subtypes of ADHD were measured both with traditionally performance-based tests, an experimental decision making task designed to study the integration of emotion and neurocognition, and a behaviour/symptom checklist of EF. Method: Subjects with ADHD-C (n=36, 23 males), ADHD-I (N=46, 22 males) and healthy controls (N=50, 32 males) between 8 and 17 years referred to Child and Adolescent Mental Health Centres were included. None of the subjects were medicated with stimulants. The neuropsychological test battery included measures of inhibition, working memory, planning, cognitive exibility and verbal uency, as well as a measure of decision making and a behaviour/symptom checklist of EF (Behavior Rating Inventory of Executive Function/ BRIEF). Results: The ADHD-C group showed signicantly impaired scores on the BRIEF (the Inhibition scale and the Behavioural Regulation Index-BRIEF), compared to the ADHD-I group and healthy controls. In contrast, the ADHD-I group showed impaired EF on the performance based measures (impaired cognitive exibility and inhibition) relative to the healthy control group. None of the ADHD subjects showed impairments on the decision making test. Conclusion: A behaviour rating scale measuring EF in a naturalistic setting was more sensitive in detecting impairments in EF in subjects with ADHD-C. In contrast, performance based measures were better at detecting EF decits in the ADHD-I group.

HT-16-04 TMS-evoked motor cortex inhibition as a biomarker of ADHD severity and effects of methylphenidate and atomoxetine D. L. Gilbert* * USA

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100 YS-01-02 Attention Decit Hyperactivity Disorder symptoms and environmental adversity in a prospective population study of preschoolers E. Paliokosta*, E. Emerson, E. Simonoff * London, United Kingdom Objective: A number of environmental factors have been associated with ADHD during school years. Although both prospective and retrospective studies suggest that ADHD symptoms in preschool children are associated with a later diagnosis of ADHD, little is known about factors affecting their presentation in preschoolers. This study aims to identify risk factors for ADHD symptoms at the age of three years using data from the UK Millennium Cohort Study (MCS). Method: A nationally representative birth cohort of 13,040 children followed up at 9 months and 3 years was included. The hyperactivity subscale of the parent version of Strengths and Difculties Questionnaire (SDQ) 3-4 was used to dene categorically ADHD caseness. Information about socio-economic position (SEP) (income; social housing; low income state benet; material hardship; maternal education; social capital), maternal characteristics (poor health or disability, self-esteem, self-efcacy and depression), parental style and child characteristics (birth weight, pre-maturity, temperament, early developmental concerns, sensory problems and epilepsy) was collected at 9 months and 3 years and were recoded for the purpose of the analysis as categorical variables indicating presence or absence of a factor. Results: Multiple logistic regression analyses revealed an independent effect on ADHD caseness of the following variables: 1) SEP: material hardship and area deprivation (OR=1.43); low maternal educational attainments (OR=1.58) and single parenthood (OR=1.27); 2) maternal characteristics: lower self-efcacy (OR=1.26); lower selfesteem (OR=1.33); higher depression (OR=1.34); and lower attachment (OR=1.21) and 3) child characteristics: male sex (OR=1.61); concerns about speech delay (OR=1.79); epilepsy (OR=1.52); hearing problems (OR=1.86); vision problems (OR=1.51); temperamental fussiness (OR=1.27) and low regularity (OR=1.15). Signicant interactions between material hardship, maternal and child variables were detected. Children with all risk factors present were 7-fold more likely to meet ADHD caseness threshold compared to children with no risk factor present. Conclusion: Our study supports the signicant contribution of early environmental factors on ADHD symptoms in preschoolers. YS-01-04 EEG parameters during working memory task and response inhibition differentiate between medicated and medication naive children and adolescents with ADHD J. Geissler*, M. Romanos, A. Fallgatter, A. Warnke, K.-P. Lesch * Wurzburg, Germany Objective: Neuropsychological proles in Attention Decit Hyperactivity Disorder are very heterogeneous, with a considerable number of patients not displaying decits in laboratory tasks despite severe symptomatology in real life. We investigated topographical and eventrelated electrophysiological parameters in combination with behavioural output during tasks designed to measure working memory as well as response inhibition to get a clearer picture of the core problems and propose ADHD endophenotypes that might facilitate diagnosis. Method: The sample comprised 74 ADHD patients ( 10.12 years) and 30 healthy controls. Patients were further divided into subgroups: under stimulant medication (N=31), medication naive (N=18) and medication discontinued three days prior to the study (N=25). A 21-channel EEG was recorded during a working memory task with varying load (1-back and 2-back) and a Continuous Performance Test (CPT) to assess response inhibition. NoGo-Anteriorization as main electrophysiological marker for inhibition describes a shift in the centroid of the brain-electric eld from parietal towards prefrontal areas whenever prepared responses are suppressed. Results: Frontocentral N2 was delayed in medication naive compared to medicated subjects, p = .007 and correlated positively with false alarms for medication naive subjects (p = .032) and mean RT for medicated patients (p = .017). On a performance level, discontinuation of medication corresponded with more errors of omission and commission compared to medicated patients. Although there was no difference in error rates during the CPT, NoGo-Anteriorization as indicator of prefrontal functioning differentiated between those on medication and those who had discontinued it, p = .036. Conclusion: Error rates showed limited discriminative power, while EEG parameters could identify patients suffering from ADHD without medication. Psychostimulants not only reduced errors, but also normalized brain activity during tasks. As this is part of a longitudinal study, it will be interesting to see the development of these putative endophenotypes for ADHD and to identify subgroup specic combinations. Psychopathy and ADHD shared an impulsive factor. There was no other clearly dened shared factor to be found. Conclusion: Findings on the PCA suggest that ADHD and psychopathy are unrelated on a symptomatic level, with the exception of impulsivity.

YS-01-03 Symptoms of ADHD and psychopathy in perpetrators A factor-analytic approach S. Boureghda*, W. Retz, M. Rosler * Saarbrucken, Germany Objective: The current study attempts to further uncover the relationship between ADHD and psychopathy in perpetrators by investigating the possibility of underlying co-morbid factors of ADHD and psychopathy using standardized instruments. Additionally, the impacts of childhood ADHD symptoms on PCL scores were assessed. Method: Principal component analyses (PCA) were performed on ADHD-SR self-rating questionnaires and on the PCL-SV, which was rated for 314 criminal offenders. Additional correlation analyses and chi-square tests were performed on scores of the two questionnaires and self reported childhood ADHD symptoms. Results: The severity of ADHD and psychopathy scores were found to be associated. Single item scores of psychopathy were also found to be associated with self-reported childhood ADHD symptoms.

Saturday, 28 May 2011, 16.0017.30 YS-02 Young Scientist Award Session II

YS-02-01 Non-shared environmental effects of birth weight on ADHD symptoms persist into early adolescence. A 10-year longitudinal twin study C. Greven*, A. Ronald, R. Plomin, A. Rodriguez * London, United Kingdom Objective: Markers of poor fetal development, especially low birth weight, have been associated with Attention Decit Hyperactivity

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101 Disorder (ADHD). However, genetic factors may underlie this association, as the same genes may be involved in low birth weight as well as ADHD. This study examines whether birth weight is associated with ADHD symptoms using a monozygotic (MZ) twin differences design to isolate non-shared environmental inuences from genetic and shared environmental factors. Method: ADHD symptoms in up to 5200 MZ twins from the U.K. population-representative Twins Early Development Study were rated by parents (ages: 2, 3, 4, 7, 8, 9, 12 years) and teachers (ages: 7, 9, 12 years). Twin birth weight was obtained via parent report when the twins were 18-24 months old. Results: Birth weight and ADHD symptoms were negatively associated. Within MZ pair comparisons revealed that the lighter twin in a pair had, on average, more ADHD symptoms than the heavier co-twin, suggesting that the association between birth weight and ADHD symptoms was non-shared environmentally mediated. Neither gestational age, gender nor socio-economic status moderated this non-shared environmental association. Effect sizes were generally stronger for more discordant twins and for parent than teacher rated ADHD symptoms. Although effect sizes were small, the magnitude of the association was consistent over a 10-year period spanning ages 2 to 12 years. Conclusion: Results suggest that poor fetal development, as evidenced by lower birth weight in relation to the co-twin, is a nonshared environmental risk factor for ADHD symptoms, with inuences that persistent into early adolescence. YS-02-03 Differences in functional connectivity patterns during response inhibition in drug naive children with ADHD H. Slama*, I. Massat, M. Kavec, S. Linotte, A. Mary, D. Baleriaux, T. Metens, P. Peigneux * Brussels, Belgium Objective: The present study aimed at identifying and comparing the regional brain activity and functional connectivity patterns associated with response inhibition, in prepubertal children with Attention Decit Hyperactivity Disorder (ADHD) and healthy controls, selected with stringent criteria minimizing potential confounds. Indeed, while neuroimaging studies have substantially contributed to better understand neural mechanisms underlying response inhibition in ADHD, it remains poorly understood in children. Moreover, high rates of co-morbidity, ongoing medications and behavioural differences in performance may be considered as potential confounds in neuroimaging studies in ADHD, each of these parameters having the potential to impact independently on patterns of cerebral activity involved in inhibition. Method: Eighteen never medicated children with ADHD combined type (8-12 years) and fourteen matched healthy participants completed fMRI (3T) studies while performing a Stop-Signal task measuring withholding of a triggered motor response. The design (Rubia, Smith, Brammer, et al. Am J Psychiatry 2005; 162:10671075), which manipulated task parameters to force each subject to fail on 50% of trials, ensured that subjects worked at the edge of their own inhibitory performance, controlling for intersubject and intergroup performance discrepancies and allowing for investigation of differences in brain activation related to inhibition and inhibition failure. Data were analysed using SPM8b. Results: Children with ADHD exhibit increased inhibition-related activation in a widespread cortico-subcortical network encompassing the right inferior frontal gyrus, the bilateral caudate nucleus (pcorr=0.022 in right caudate) and lentiform nucleus. Differential functional connectivity in ADHD compared to healthy participants is revealed between right caudate nucleus and a large network of subcortical and cortical regions: left postcentral gyrus, left inferior frontal gyrus, left superior frontal gyrus, left middle frontal gyrus, right precuneus and left anterior cingulate. Conclusion: Our ndings yield novel evidence for a core functional neuroanatomical network subtending response inhibition-related processes in ADHD children that may participate to the pathophysiology and the expression of clinical symptoms in this disorder.

YS-02-02 Interactions between self-regulation and aspects of parenting in predicting symptoms of Attention Decit Hyperactivity Disorder A. Lordos*, K. Fanti * Nicosia, Cyprus Objective: The purpose of this study was to explore the association between self-regulation and aspects of parenting in predicting Attention Decit Hyperactivity Disorder (ADHD). Method: A Greek Cypriot community sample of 1755 school age children and both of their parents completed questionnaires which included measures of ADHD symptoms, parental involvement, positive parenting, parental stress, and self regulation. Separate hierarchical regressions were conducted for the father and mother data sets, with ADHD symptoms as the dependent variable. The rst block of predictors included age and gender, the second block included the parenting variables, while self-regulation was entered in the model as the third block. Two-way and three-way interaction terms were inserted into the model as the 4th and 5th blocks. Results: Among boys, an interaction effect was found between maternal stress and maternal involvement, suggesting that maternal involvement is a protective factor at low levels of maternal stress but a risk factor at high levels of maternal stress. Additionally, an interaction effect was found between parental stress and positive parenting, suggesting that parental stress is a particularly acute risk factor for ADHD symptoms when positive parenting is absent. Among girls, an interaction effect was found between self regulation and maternal involvement, suggesting that maternal involvement is only protective against ADHD symptoms in girls with high self regulation, while it has no such impact on girls with low self regulation. Conclusion: This study highlights the complex interaction between self-regulation and aspects of parenting in explaining symptoms of ADHD. Further elucidation and validation of these interaction effects could contribute to a better understanding of the role of parenting in ADHD, with signicant implications for clinical practice.

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102 YS-02-04 Association between dopamine--hydroxylase gene and Attention Decit Hyperactivity Disorder in Han Chinese boys N. Ji*, L. Liu, H.-m. Li, Z.-h. Li, Q.-j. Qian, L. Yang, Y.-f. Wang * Beijing, Peoples Republic of China Objective: ADHD is a highly heterogeneous disease, and appears its motor and cognitive symptoms are mediated differently. Different genetic factors may operate for males and females. Genetic polymorphisms of DBH gene may lead to altered NE neurotransmission. Our aim was to investigate the association of ADHD and polymorphisms in the DBH gene in Han Chinese ADHD boys. Method: A total of 1075 male ADHD trios were included. The diagnosis of ADHD and its subtypes as well as evaluation of comorbidities were ascertained as per the criteria of DSM-IV. 8 SNPs (rs1076150, rs1611115, rs1108580, rs2873804, rs1548364, rs2519154, rs2073837, rs129882) of DBH gene were genotyped implementing TaqManTM real-time PCR genotyping technique. TDT was employed for statistical analyses; permutation tests were used to evaluate gene-wide statistical signicance. Results: After permutation we found:1) In all ADHD trios (n=1075), A allele of rs2073837 showed over-transmission (P=0.0492); C allele of rs129882 showed a trend of over-transmission (P=0.0606). 2) In ADHD-C trios (n=497), A allele of rs2073837 (P=0.0192) were overtransmitted. 3) In ADHD comorbid oppositional deant disorder trios (n=331), A allele of rs2073837 (P=0.0090) and C allele of rs129882 (P=0.0020) were over-transmitted. Conclusion: Our results supported that DBH gene may be implicated in the pathophysiology of ADHD. Especially, strong association was found between the rs129882, rs2073837 polymorphisms and male ADHD comorbid ODD. Rs1611115 didnt show any associations as we investigated before in Chinese samples, which may due to the enlarged sample size. Withdrawal and Competence scores. Oppositional deant disorder/ conduct disorder comorbidity was more common in ADHD C. There were no differences in terms of anxiety/depression, parental symptoms, neuropsychological measures, and treatment response. Conclusion: Our results showed that previous differences reported between ADHD subtypes were also valid in this Turkish sample. There were similarities and differences between the subtypes, indicating that more detailed analysis, using other methods such as neuroimaging and genetics, can be helpful to have a better understanding of ADHD.

P-01-02 Comparison between parental SNAP-IV, teachers SNAP-IV and T.O.V.A. in regards to attention and impulsivity in children with ADHD V. Hercigonja-Novkovic*, D. Kocijan-Hercigonja * Zagreb, Croatia Objective: Objectives are: 1.to establish the co-relation between parental and teachers SNAP-IV in diagnostic procedures of ADHD 2. to establish co-relation between parental and teachers SNAP-IV and objective measure of attention and impulsivity; obtained in clinical setting - T.O.V.A. Method: Sample is 40 school aged children (age 7-10), of both genders, referred to clinic for ADHD diagnosis. Parents will ll in the SNAP-IV form and the same SNAP-IV will be lled in by childrens teachers. Then the comparison will be made. Children will be given the test of variables of attention in our clinical setting-T.O.V.A., and the results on variables of attention and impulsivity will be compared to those on SNAP-IV from both parents and teachers. Results: Results will show that test of variables of attention more accurately measures attention and impulsivity in children with ADHD. Results will show that teachers SNAP-IV form is more objective and similar to clinical results than parental SNAP-IV. Conclusion: SNAP-IV is good and relevant part of diagnostic procedure, but one must take into account the subjectivity of it, especially of the parental SNAP-IV.

Friday, 27 May 2011, 14.3016.00 P-01 Diagnosis: Children and adolescents I

P-01-01 Attention Decit Hyperactivity subtypes: Comorbidity, treatment response and parental characteristics O. Oner*, P. Oner, E. Cop, K. Munir * Ankara, Turkey Objective: To investigate the differences between Attention Decit Hyperactivity Disorder (ADHD) Combined (C) and predominantly inattentive (PI) subtypes in terms of social competency, emotional and behavioral problems, comorbidities, parental psychopathology, socioeconomic status (SES), cognitive measures, and treatment response in a clinical sample from Turkey. Method: ADHD and comorbid disorders were diagnosed with semistructured interview in 537 children and adolescents. Child Behavior Checklist (CBCL), Teacher Report Form (TRF), Conners Parent and Teacher Rating Scales (CPRS-CTRS) were obtained from the teachers and parents. Parental symptoms were evaluated with Adult Self Rating (ASR). Trail Making Test-A and B and Weschler Intelligence Scale for Children-Revised (WISC-R) were used to measure neuropsychological performance. One-month treatment response was dened as 25% or more decrease in pre-treatment CPRS and CTRS Total scores. p\.0018 were dened as statistically signicant. Results: ADHD PI subjects were more likely to be older, female, and from higher SES. ADHD C subjects had higher CBCL and TRF Aggression, Delinquency and Social Problems scores and lower

P-01-03 Validity of the DSM-IV factor structure of ADHD in young adults D. Baeyens*, L. Van Dyck, M. Danckaerts * Antwerp, Belgium Objective: DSM conceptualization of ADHD portrays inattention (IA) and hyperactivity/impulsivity (H/I) as two separate dimensions. The criteria in DSM-IV were empirically derived from clinically referred children and adolescents. We set out to determine whether the current factor structure is applicable to young adults (16-25 years old) with and without ADHD. Method: Parent and self reports (4-point Likert scale) on DSM-IV ADHD symptoms were obtained for 1716 (718M/998F) young adults from a Flemish community-based sample of which 252 had clincical scores on the Adult ADHD Rating Scale (Kooij & Buitelaar, 2005). Conrmatory (CFA) and exploratory (EFA) factor analysis were used to examine the data structure. Results: CFA for parent and self-report data revealed that single (IA/ H/I), two (IA?H/I) or three-factor (IA?H?I) models did not meet the minimum thresholds for goodness-of-t. For both informants data t the three-factor model better than a single- or two-factor model. Overall, parent ratings t the model better than self-reports. EFA indicates that data from self ratings support a ve-factor structure

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103 (active IA, passive IA, H, I and emotional restlessness) whereas parent ratings reveal the current DSM dimensions IA and H/I. Conclusion: CFA indicates that the current conceptualisation of ADHD is not supported by data on young adults: neither a single nor a two- or three-factor model of ADHD meets the criteria for goodnessof-t. Of these models, ADHD symptoms in young adults are best described by a three-factor model. This nding highlights that the current DSM taxonomy of ADHD is specically focusing on a childhood population and does not fully account for the more complex nature of adult ADHD. Further evidence for this was found in EFA on self report data which suggests that more differentiation, even into ve factors, is needed. As parent reports rather support the current DSM two-factor structure, implications for the informant agreement will be critically discussed. Method: Patient records of the preceding 12 months at a child psychiatric unit in Cyprus were investigated to identify cases where at least one of the three related symptom categories inattentiveness, hyperactivity or impulsivity was included in the initial referral note. 53 cases were identied (47 boys) with a mean age of 9.77 years (range 4 to 17 years) for inclusion in the study. For these cases, oneway ANOVA was conducted with type of ADHD-like presenting symptoms - Hyperactive/Impulsive (N=24), Inattentive (N=9), or Combined (N=20) as the factor and with the nal diagnoses as dependent variables. Results: Among the overall sample, 29 patients (55%) were ultimately diagnosed with ADHD, 17 patients (32%) with Learning Difculties, 10 patients (19%) were deemed to be abused, 7 patients (13%) were diagnosed with Autism Spectrum Disorder, 6 patients (11%) with Conduct Disorder and 6 patients (11%) with Anxiety Disorder. By cluster of symptom type, Anxiety Disorder was significantly predicted (p\0.05) by the presence of only inattentive symptoms, while Conduct Disorder was signicantly predicted (p\0.05) by the presence of only hyperactive/impulsive symptoms. Conclusion: This study highlights the importance of exploring alternative potential diagnoses in children and adolescents referred for ADHD assessment, without rushing to accept ADHD-like symptoms at face value. Learning Difculties, Abuse, or Autism are particularly likely possibilities. Despite limitations in statistical power, this study suggests that an investigation of possible alternative diagnoses on the basis of specic ADHD-like presenting symptom clusters might be a promising avenue for research and clinical practice.

P-01-04 An experiential qualitative diagnosis instrument for self-image in ADHD children G. Cucu-Ciuhan* * Pitesti, Romania Objective: The objective of the study was to create and validate some qualitative experiential diagnostic techniques of the self-image in ADHD children. Method: There were two phases involved: the creation of the experiential diagnostic techniques and the development and validation of the video records check list for the self-image.Two classic projective techniques (Draw a person test and Tree test) were transformed in dynamic experiential exercises.The study involved 10 children, 5 with ADHD and 5 normal.The video records check list for the self-image was developed using the group of experts method. Results: The value of the Spearman Rho correlation coefcient indicated a medium to strong correlation (Spearman Rho=0,5, a=0,000) between the raters evaluations. The value of the Alpha Cronbach coefcient indicated a strong internal consistency (.914). To evaluate the discriminate validity we used the independent samples T test. The T test reveled a signicant difference between the ADHD group and the control group for the total score of the video records check list for the self-image (t=2,294, sig=0,029). Conclusion: The video records check list for the self-image has good reliability and good content and discriminate validity and can be used for qualitative diagnosis of the self-image in ADHD children.

P-01-07 The strength-based interview of behaviors, parent edition: Inter-rater reliability and factor structure P. Robaey*, R. Schachar, N. Forget-Dubois, G. Dionne, M. Boivin * Ottawa, Canada Objective: A symptom-based rating then creates a highly skewed and truncated distribution of scores in the normal population, because it only rates normality as an absence of symptom The objective of the study was to test the distribution, the inter-rater reliability, and to examine the factor structure of a strength-based interview for ADHD The Strength-based Interview of Behaviors, Parent edition (SIB-PE) was developed and tested from a previous clinical instrument, the Parent Interview for Child Symptoms (PICS). Method: The SIB-PE rates each symptom/strength on a scale from -3 to ?3. We obtained data on 298 twins (age: 100 months). 55 interviews were randomly selected to be videotaped and coded twice independently in order to assess inter-rater reliability Results: The SIB-PE scores were normally distributed for ADHD combined scores, but also for Inattention and Hyperactivity/Impulsiveness scores. The modes of all distributions were centered on zero. Kappas values increased with the number of symptoms and reached 1 for a total of 5 symptoms (ADHD Hyperactive/Impulsive subtype) to 6 symptoms (ADHD Inattentive and Combined subtypes), which gives great condence in the diagnostic inter-rater reliability using the current diagnosis thresholds. An exploratory factor analysis of the scores yielded four factors: one hyperactivity/impulsiveness factor and three attention factors that seemed to match Posners attention networks: executive, alert and orienting. Conclusion: A strength-based interview may thus constitute a useful tool for genetic studies by increasing the range of rating of ADHDrelated behaviors, for reliably diagnose ADHD and provide subtypes that may be closer to attention physiological brain systems.

P-01-05 When appearances can deceive: Final diagnoses of children and adolescents presenting with inattentive, hyperactive or impulsive symptoms in an out-patient child psychiatric unit. E. Lordou*, A. Lordos, C. Lazarou, A. Lazarou, P. Mama, A. Paradeisioti * Nicosia, Cyprus Objective: The purpose of this study was to investigate the extent to which presenting symptoms of inattentiveness, hyperactivity or impulsivity, actually map out to Attention Decit Hyperactivity Disorder (ADHD) once the clinical assessment process has been completed; and if not, to explore whether distinct clusters of ADHDlike symptoms differentially predict alternative diagnoses.

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104 P-01-10 The comparison between children with Attention Decit Hyperactivity Disorder with their parents in integrated visual and auditory test results R. Rostami*, M. Bidadian, J. Zarei * Tehran, Iran Objective: The purpose of this study was the comparison between children with Attention Decit Hyperactivity Disorder (ADHD) with their parents in integrated visual and auditory (IVA) continuous performance test (CPT) results. The hypothesis in this study was that the parents of children whom were diagnosed as with Attention Decit Hyperactivity Disorder had themselves this disorder in their childhood. Method: This study was performed between November 2010 and January 2011. This study was retrospective design. Participants of this research included 60 adults, 20 male and 40 female who were the parents of children whom were diagnosed as ADHD from Atieh group. Participants were between 25-50 years old and completed the IVA test. Their children completed this test before their treatment. For analyzing the data correlation was used. Results: Results showed that there is a signicant relationship between results of IVA test for parents and their children. Conclusion: The ndings of this research suggest that most of the parents having children with ADHD have inattentive symptoms. Most parents are categorized into predominantly inattentive subtype. These results are discussed in regard to the results of follow-up studies of those diagnosed with ADHD which indicate signicant continuation, impairment and persistence into adulthood that has a number of negative consequences in economic, occupational, social, academic, marital and parenting domains. Most adults with ADHD are not recognized and remain untreated or treated for other comorbid mental disorders. The problems discussed above indicate the importance of an exact method such as IVA for the diagnosis of ADHD. were no differences between both groups regarding age and educational level. However, we found a signicant difference in anxiety scores measured by STAI (p\0.05), children with ADHD having higher scores than their siblings. Depressive scores on CDI did not differentiate between ADHD probands and sibs. Conclusion: Our results suggest that ADHD is associated with anxiety, even if there is no formal diagnosis of Anxiety Disorder. This association may not be related to psychosocial factors or family environment, although other alternative explanations are possible and are being investigated. Although previous studies have demonstrated higher anxiety levels in parents of children with ADHD, which might be associated to the burden of an ADHD offspring, the present study suggests that siblings without the disorder do not have higher anxiety levels.

P-02-02 The risk of overweight and obesity in boys with Attention Decit Hyperactivity Disorder T. Hanc*, A. Slopien, T. Wolanczyk * Poznan, Poland Objective: Comparison of the prevalence of overweight and obesity among boys with Attention Decit Hyperactivity Disorder (ADHD) and the general population (GP) 2) identifying factors associated with risk of obesity in boys with ADHD. Method: The study sample consisted of 71 boys with a conrmed diagnosis of ADHD, between 6-17 years of age. The study was a cross-sectional and included measurement of height and weight and questionnaire survey. was calculated. Excess weight and obesity were diagnosed using Body Mass Index (BMI) and the WHO standards. Nonparametric Kruskal-Wallis test, chi2 method and Mann-Whitney test were used in statistical analysis. The signicance level was set at p\0.05. Results: Comparison of mean standardized values of height (z=0.12), weight (z=0.18) and BMI (z=0.22) of boys with ADHD and GP (n=18828, 7-17 years) showed no difference. The prevalence of overweight did not differ between the sample (14.08%) and GP (15.52%). However, a statistically signicant difference was found between the incidence of obesity (ADHD: 7.04%, GP:2.67%). The risk of overweight/obesity in our sample was related to birth weight above 4500g (high birth weight - HBW). BMI of boys with HBW (z=1.75) was signicantly higher than boys with a birth weight between 2501-4500g (normal birth weight - NBW, z=0.26). The incidence of overweight/obesity was also higher (4-fold) in boys with HBW than NBW. The level of BMI and risk of overweight and obesity were no signicantly inuenced by severity of ADHD symptoms, comorbid disorders and prior treatment. Conclusion: The risk of obesity were more than 2.5 times higher in boys with ADHD than in the general population of Polish boys. The predisposing factor for excessive body weight in this group is high birth weight. This may suggest a common genetic basis of ADHD and obesity, but also may indicate the crucial role of dietary habits prevailing in the family. High birth weight in the general population is also a risk factor for obesity later in life. Therefore, in subsequent studies it should be investigated whether the increased risk of obesity in boys with ADHD is not associated with a higher incidence of high birth weight in this group.

Friday, 27 May 2011, 14.3016.00 P-02 Co-morbidity: Children and adolescents I

P-02-01 Anxiety symptomatology in ADHD children A comparison study between probands and their siblings D. Segenreich*, R. Suwwan, J. Sergeant, P. Mattos, D. Fortes, J. Torres, L. Novo * Rio de Janeiro, Brazil Objective: A higher prevalence of Anxiety Disorders is well documented in ADHD children living in culturally and economically heterogeneous parts of Brazil. However, anxiety levels which do not reach DSM IV cutoff for formal diagnosis notwithstanding their relevance in clinical practice has not been studied in Brazil. The aim of this study was to perform a comparison of anxiety levels between children with ADHD and their siblings without ADHD. Method: Fifty ADHD probands and thirty four siblings (n=84) were evaluated for ADHD, depressive and anxiety levels, and also psychiatric comorbidity. ADHD and comorbid disorders were assessed with the semi-structured interviews (K-SADS and P-Chips, respectively) by trained psychiatrists in both ADHD probands and their sibs. They were also evaluated with Child Depressive Inventory (CDI), Stait-Trait Anxiety Inventory (STAI) for children. Probands and siblings who presented with a full mood or anxiety DSM-IV disorder were excluded from the study in order not to inate the symptom count for subthreshold cases. Results: Seventeen probands and ten siblings were excluded from the original sample because of present mood or anxiety disorder. There

P-02-03 Game addiction and ADHD in early elementary age children S.-C. Kim*, I.-W. Chung, S.-W. Park, H. Yoo, S.-C. Cho * Goyang, Republic of Korea

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105 Objective: The purpose of this study was to survey the relationship between early elementary age childrens game addiction and ADHD, and to investigate the associated psychopathology and parent-child relationship problems. Method: The study included 2481 boys and girls, with an age between 6 to 8 (rst-graders with mean age years old), collected from elementary schools in Paju city, South Korea, in 2010. Primary caregivers were required to complete Korean ADHD Rating Scale (K-ARS) as screening tool. Those whose K-ARS scores exceeded 19 point were required to perform Korean Child Behavior Checklist (K-CBCL). To conrm the diagnosis, the ADHD section of the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) was performed by a experienced child psychiatrist. Thirty-six children who were screened by K-ARS and K-CBCL completed the Childrens Depression Inventory (CDI) and the State-Trait Anxiety Inventory for Children (STAI-C). Their primary caregivers also completed the Internet Game Addiction Scale for Children and the Parent-Child Communication Scale. Correlation, chi-square test and logistic regression analysis were conducted to investigate the associated psychopathology of game addiction and ADHD. Results: Signicant difference in game addiction score was observed between ADHD group and non-ADHD group. There was also signicant difference in the frequency of problematic game user and non-problematic game user according to ADHD diagnosis. Logistic regression showed that diagnosis of ADHD and male gender increased the odds of problematic game use. Childrens depression, anxiety, and parent-child communication showed no association with the development of game addiction score in this age-group. Conclusion: This study shows that ADHD is highly related to problematic game use in early elementary age children. (ANOVA: Metalinguistic _ F (2,29)= 15.86, p B .05; Verbal uency _ F (2,29)= 6.19, p B .05) and one executive function component (ANOVA: Shifting and working memory _ F (2,29)= 14.22, p B .05). Participants in Cluster 1 manifested sufcient language competence and shifting working memory than participants in cluster two who manifested vulnerability in shifting working and metalinguistic component. Participants in cluster 3 showed impairment in inhibitory attention control and verbal uency. Conclusion: ADHD children present different language organizations/or impairment at various levels of severity and language complexity components. On the basis of the language organization characteristics or impairment correspond different clinical proles and different severity EF impairment.

P-02-05 Does the clinical prole of children with Attention Decit Hyperactivity Disorder with comorbid mood disorder differ from those without comorbid mood disorder? P. Palaniappan*, S. Seshadri, S. Srinath, S. Girimaji * Bangalore, India Objective: Though there are many studies on ADHD (Attention Decit Hyperactivity Disorder) and co-morbid mood disorder, only few studies have analyzed clinical prole of ADHD children who later develop mood disorder. Hence we studied the factors in ADHD subjects (children and adolescents) who later develop mood disorder and assessed the global functioning in ADHD subjects with and without comorbid mood disorder. Method: Subjects aged 6 to 16 years were screened for diagnosis of ADHD using DSM IV TR criteria at index consultation (N=60) with informed consent. Comorbidities were diagnosed using K-SADS PL and then subjects were grouped as those with (N=14) and without (N=27) co-morbid mood disorder (Unipolar depressive disorder and Bipolar affective disorder). Severity of ADHD and Global functioning were assessed by Conners Parents 10 item abbreviated index and Children Global Assessment scale (CGAS) respectively and the results were compared using independent t test. Results: Age range of subjects with and without co-morbid mood disorder was 1016 years and 6-9 years respectively. When compared to subjects without co-morbidity, subjects with co-morbid mood disorders showed signicant family history of mood disorder (p=0.07) and higher parental discord (p=0.04). No statistically signicant difference was found in gender, Temperament and Upbringing pattern. First episode of all subjects with co-morbid bipolar affective disorder (N=8) was hypomania. None of the subjects with mania suffered from pervasive irritable mood and rapid cycling subtype. Subjects with comorbid bipolar affective disorder had Conduct disorder (37%), Obsessive compulsive disorder (37%) and Substance use disorder (25%), whereas subjects with co-morbid unipolar depression had Oppositional deant disorder (33%). Subjects with co-morbid mood disorder scored poor on global functioning (p=0.04). Conclusion: ADHD children with family history of mood disorder and signicant parental discord have higher risk of developing mood disorder later in life.

P-02-04 Neuropsychological proles in ADHD preschoolers: Relation between executive functions and language competences M. G. Melegari*, M. Innocenzi, A. Costa, L. Canzano, F. Baccarin, F. Martines, S. LaPietra, A. Marano * Roma, Italy Objective: The present study investigates the relation between executive functioning (FE) and language-processing in a sample of ADHD preschoolers. Clinical implications of the different neuropsychological proles are discussed to explore the controversy hypothesis of co-morbidity between the two impairments (Riccio, Hynd, Cohen, Hall, & Molt, 1994). Method: Sample: 31 preschooler ADHD, 64.5% with a history of speech-language impairment (whose 41.9% treated by child neurologists). Assessment (using standardized test): EF measures=planning, attention, Shift inhibitory control and Working memory; Language measures= receptive and expressive lexical and phonological competences; narrative competence categorial and phonemic uency.Statistical analyses Descriptive and correlation analysis between measures, Exploratory factor analyses (EFA) and Cluster analyses were conducted. Results: Correlation analysis showed moderate coefcient values between language and EF variables (r=B.30). EFA identied a consistent factorial solution on language components (3 factors; explained variance 72.32%): Phonological and Lexical; Metalinguistic; Verbal uency; and another consistent factorial solution regarding to executive functions (2 factors, explained variance 60.76%): attention-planning; shifting - working memory. A threecluster solution was selected: Clusters had different patterns. Cluster analysis on factorial scores showed signicant difference between the three clusters regarding to language complexity components

P-02-06 Comorbid Attention Decit Hyperactivity Disorder in a sample of Brazilian children with Attention Decit Hyperactivity Disorders (ADHD) S. M. M Palma*, S. Rizzutti, L. F. Coelho, S. A. Oncalla, D. L. F. Barbosa, R. Barbosa, M. C. Miranda, O. F. A. Bueno, M. Muszkat

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106 * Sao Paulo, Brazil Objective: This study evaluated the clinical aspects related to ADHD and its comorbidities. Method: Evaluation of 250 children aged 7 to 14 years enrolled in NANI/UNIFESP complaining of difculties in attention and/or hyperactivity, by a multidisciplinary team and application of extensive battery of neuropsychological tests: DSM-IV criteria, Continuous Performance Test (CPT), ve subtestes from Automated Working Memory Assessment (AWMA), Behavior Rating Inventory of Executive Functions (BRIEF), Child Behavior Checklist (CBCL) and Child Behavior Evaluation Scale for Teachers (Conners Scale). Results: 116 children (88 M and 28 F) fullled the criteria for ADHD, among which 45 were of the inattentive type, 59 of combined type and 12 were hyperactive/impulsive. DSM-IV 48 cases (41,5%) had complained of comorbidities, being that 23 (20%) with anxiety disorders, 14 (12%) with oppositional deant disorder, 3 (2,5%) with conduct disorder, 5 (4,5%) with bipolar disorder and 3 (9%) met criteria for major depression (9%). Conclusion: Attention Decit Hyperactivity Disorder (ADHD) is a highly prevalent disorder among school age1. Children and it is now recognized as an important condition because of its poor outcome and strong association with comorbidities2. These patients need more attention and personalized treatment strategies. The impact of comorbidities may modify the therapy, rehabilitation strategies and prognosis. rstly, to establish psycholinguistic approach to cross-cultural research of children with ADHD, and secondly, to compare peculiarities of speech and language activities of American and Ukrainian children with ADHD of the age 8-10 years. The core of psycholinguistic approach is psychology of meaning. Method: The typology of meaning was proposed for speech and language activity research. Three types of meaning were used: lexical, sentential, discourse. The lexical meaning was represented by the associative meaning (free associative experiment after J. Deese), connotative meaning (semantic differential after Ch. Osgood).The sentential meaning comprises of propositional analysis. The discourse meaning was studied by frame analysis of story-telling. The study groups consisted of 24 Ukrainian children and 22 American children (mean age 10 years). The method of free associative experiment is used for revealing the associative word-meaning, which characterizes speech and language competence. The method of semantic deferential allows revealing emotional attitude to neutral notions, which shows the emotional liability of the person in communication. The propositional analysis is based on theory Fillmore (1968) and characterizes the thinking process. The frame analysis (Zasyekina, 2006) for discourse meaning allows revealing cohesion and coherence of the story and reects social-pragmatic skills and feeling of the context in communication. Data analyses were carried out using SPSS. T-tests were used to examine differences between two groups. Results: The great discrepancy in different types of meaning was not established. The main differences are observed in connotative meaning, which has higher indices in Ukrainian group than in American one. Conclusion: The culture is not specic feature for children with ADHD as age and gender are. It gives a great opportunity for international contribution to ADHD treatment.

P-02-07 A clinical study of phenomenology and comorbidity of ADHD in Indian children A. Vaithiyam*, K. Devendran * Madurai, India Objective: To discuss the phenomenology and co morbidities of pediatric BPD. Method: 60 subjects (6-16 years) attending child guidance clinic at Ram Psychiatry Hospital & Institute who fullled DSM-IV-TR 2000criteria for BPD were assessed using K-SADS-PL, child mania rating scale (CMRS), child depression rating scale (CDRS) ADHDRS and C-GAS. Results: All the subjects were diagnosed as BPD- I. Their mean chronological age was 13.6 ? 1.7 years and the mean age at onset of BPD was 12.5 ? 1.9 years. The commonest symptoms in mania were increased goal directed activities, distractibility (100% each), elation (100%), and grandiosity (96.6). Irritability and rapid mood swing were reported by parents in 73% and 40% subjects respectively. Psychotic symptoms were present in 11.9% of the subjects. 5(8.3%) subjects had chronic course, and one (1.6%) had rapid cycling, 10(16.1%). Two subjects had ADHD (3.2%), and one had ODD (1.6%). Conclusion: Differentiation of co morbid disruptive behavior disorders especially ADHD from BPD is possible with respect to age of onset, quality of the disturbed mood, and the course of each disorder.

P-02-09 Analysis of leiter-r proles in comparing ADHD children with high functioning pervasive developmental disorder not otherwise specied in preschoolers F. Manti*, A. Fabrizi, F. Giovannone * Roma, Italy Objective: The aim of this study was to investigate cognitive proles, emotional and behavior problems between a group of children with Attention Decit Hyperactivity Disorder (ADHD) with a group of children with high-functioning (IQ C 80) pervasive developmental disorder not otherwise specied (PDDNOS). Method: The current study investigate 30 children (15 ADHD and 15 PDDNOS) ranging in age from 48 to 60 months. The diagnosis of children were based on DSM-IV TR criteria and established by three clinicians (two psychiatrists and one language and speech therapist), by several clinical interviews on development and symptoms of children lled out by parents; by observation of children and neuropsychological measures (Leiter-R Test and Child Behavior Checklist 1.5-5). In addition, parents were asked on the developmental history of their children (speech and language development, attention problems, social interaction, sleep, motor functioning and diet). All analyses were carried out by Statistica 8 software. Given the small sample size data were analyzed by independent sample t-test to assess the differences between ADHD group and PDD NOS group. Results: It was found that ADHD group had higher scores on subtests of Leiter-R than PDDNOS group. Subtests Repeated Patterns (p=0,0036), Delayed Recognition (p=0,001), Forward Memory (p=0,02) and Attention Sustained (p=0,000086) discriminated best. Conclusion: This study claried difference in cognitive function and autistic symptom proles between ADHD and PDDNOS children. Often, deductive and inductive cognitive skills were affected by emotional-behavior component. It was concluded that based on

P-02-08 The impact of culture on language and speech competence of children with ADHD L. Zasyekina* * Lutsk, Ukraine Objective: The assessment of speech and language competence from culture perspective is difcult by linguistic variation that impacts on verbal presentation. The two main objectives of the research are,

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107 intelligence scores, ADHD and PDDNOS emerged as distinct categories, whereas the combined diagnosis did not. Conclusion: The results of our study reveal a high phenotypical overlap between PDD and ADHD. P-03-02 Family adversity risk factors for ADHD and associated disruptive behaviour disorders in Singapore N. Lim-Ashworth*, Y. P. Ooi, C. G. Lim, D. S. Fung, R. P. Ang * Singapore, Singapore Objective: This study examined whether family adversity predicted disruptive behaviour disorders (DBD) (including ADHD, CD and ODD) when compared to clinically referred children who did not receive a diagnosis. We also explored the associations between family adversity and behavioural and emotional problems as measured by the Child Behaviour Checklist (CBCL). Method: The sample consisted of 178 children aged 9 to 17 seen at an outpatient psychiatric clinic in Singapore. 77 of the children satised the DSM-IV criteria for DBD and the remaining 101 did not receive a clinical diagnosis. Their parents completed a computerised diagnostic interview (C-DISC), a clinical interview and the CBCL. The family adversity index was summed from six items (e.g., low SES, large family size) on the clinical interview; 1 point was given for the presence of each item. Results: Analyses from logistic regression indicated that the family adversity index signicantly predicted DBD, with 3.3% of the variation accounted for by the index (OR = 1.44, Sensitivity = 55%, Specicity = 60%). Correlational analyses suggested that the index was associated with the following CBCL scales: Total Problems, r(176) = .16, Thought Problems, r(176) = .17; Aggressive Behaviour, r(176) = .16, p\.05, and Externalising Behaviour, r(176) = .22, RuleBreaking Behaviour, r(176) = .29, p \ .01. Conclusion: Our ndings suggest that a high family adversity increase the risk of a DBD diagnosis. The presence of adverse familial factors was related with mainly externalising behavioural issues. Identication of at-risk children should be considered, especially from the school and community levels. Interventions aimed at equipping these families with protective resources and reducing the impact of the adversity may be benecial.

P-02-10 Neurological soft signs in children with Attention Decit Hyperactivity Disorder compared to Asperger syndrome E. Dagati*, L. Casarelli, M. Pitzianti, A. Pasini * Ciampino, Italy Objective: Motor dysfunction is not just an additional characteristic of Attention Decit Hyperactivity Disorder (ADHD) and Asperger Syndrome (AS), but underlies some of their core characteristics.In this study we evaluated children with ADHD and AS for neurological examination abnormalities compared with healthy children. Method: 33 drug-naive boys were enrolled: 11 ADHD, 11 AS, and 11 healthy children matched for age, sex, and IQ. Subjects were 8-12 years of age with an IQ[80. Motor function was assessed using the revised Physical and Neurological Assessment of Subtle Signs. Three variables were obtained: total speed of timed movements, total overow, and total dysrhythmia. Effects of age, group, and IQ were assessed. Results: Total speed of timed movements is slower in AS than in ADHD and healthy children, independently of age and IQ. No difference in total overow was found. Total dysrhythmia seemed to differentiate ADHD and AS from controls. Conclusion: Total speed of timed movements differentiated AS children from ADHD and controls, whereas total dysrhythmia was present in both ADHD and AS patients but not in controls. Dysfunction of the fronto-striatal-cerebellar networks related to motor control, reported in boys with ADHD and AS, could be at the base of our ndings.

Friday, 27 May 2011, 14.3016.00 P-03 Co-morbidity: Children and adolescents II

P-03-01 Pervasive developmental disorders (PDD) with Attention Decit Hyperactivity Disorder (ADHD) and chronic multiple tic disorder (CMTD) in children and adolescents M. Igor* * Kyiv, Ukraine Objective: PDD, ADHD, CMTD are neurodevelopment disorders thought to involve frontostriatal brain regions. While from a neurobiological perspective it is possible, and even highly likely, that ADHD and PDD might clinically co-exist, our major diagnostic classication systems (DSM-IV-TR and ICD-10) currently preclude such a dual-diagnosis.This study aims to evaluate neurodevelopment spectrum symptoms in children with, as well as the comparison of tthree PDD subsamples of children with ADHD (PDD?ADHD), without ADHD (PDD-ADHD), with CMTD/ADHD (PDD?CMTD/ ADHD). Method: Participants are 249 children with PDD. Dimensional and categorical aspects of ADHD, PDD, CMTD are evaluated using a diagnostic symptom checklist according to DSM-IV. Results: Of the sample, 84.7% fulll DSM-IV criteria for ADHD, -20.1% for CMTD. The comparison of the PDD?ADHD and the PDD-ADHD samples reveals differences in age and IQ. Correlations of ADHD and PDD show signicant results for symptoms of hyperactivity with impairment in communication and for inattention with stereotyped behavior. Item proles of ADHD symptoms in the PDD?ADHD sample are similar to those in a pure ADHD sample.

P-03-03 ADHD and learning disabilities as factors of school unsuccess M. Inna*, M. Igor, K. Svetlana * Kyiv, Ukraine Objective: The aims of this study was to investigate the prevalence of ADHD, school skills and behavioral disorders and examined academic success of school children with ADHD subtypes, oppositional (ODD) and conduct (CD) disorders. Method: Were examined 646 children: 482 at a secondary school and 164 at a special school for students with learning disabilities (LD). The investigation included: 1) screening of parents through the CSI 4, CBCL and Connors Parent Rating Scale, 2) screening of teachers with scales NICHO Vanderbilt and Connors Teacher Rating Scale. Results: ADHD at the Kievs school children is more common than in Europe and the USA: the 12,2% in secondary school, 27,4% in special school. It was establish gender differences: the accumulation in special school ADHD boys with hyperactivity and impulsivity (ADHD-H/Im) and girls with inattention (ADHD-H/Im). 31,7% children with ADHD had ODD, 39,4% - CD, 31,0% - LD. In children with ADHD-H/Im, along with academic problems, there have been more severe disruptions of school adaptation than in children with ADHD-I and students without ADHD.

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108 Conclusion: Special schools provide better conditions for the integration of ADHD children. LD can mimic the symptoms of ADHD. Students with ADHD should always be screened for LD. tolerance, emotion regulation difculties. This group presents a major probability of bipolar disorder diagnostic.

P-03-04 Attachment patterns in Attention Decit Hyperactivity Disorder with and without Severe Mood Dysregulation: Preliminary results C. Paloscia*, C. Rosa, F. Manaresi, R. Alessandrelli, A. Marianecci, A. Pasini * Rome, Italy Objective: Severe mood dysregulation (SMD) is a syndrome characterized by severe, nonepisodic irritability and by hyperarousal symptoms typical of mania but who lack the demarcated periods of elevated or irritable mood specic of bipolar disorder. SMD occurs in about 30% of children and adolescents with Attention Decit Hyperactivity Disorder (ADHD). We compared attachment patterns in ADHD with and without SMD. Method: This study compared 24 boys with ADHD (7-13 years) to 20 boys (7-13 years) with ADHD and SMD. Patients were admitted consecutively to Division of Child Neuropsychiatry of Tor Vergata University and to a child outpatients service. Clinical evaluation of children was performed with the Kiddie Schedule of Affective Disorders (K-SADS) and Conners Rating Scale. All patients were evaluated with Separation Anxiety Test to assess attachment patterns. Results: Signicant differences were found between ADHD and ADHD with SMD. ADHD Children with SMD showed an higher prevalence of insecure and disorganized attachment compared to group without SMD (p\0.001). Conclusion: Attachment patterns could represent an important risk factor to develop severe mood dysregulation in ADHD. Further studies will be needed to clarify the nature of this association.

P-03-06 Attention Decit Hyperactivity Disorder: Co morbidity and multimodal management of children attending community clinic in a patch of Midessex, UK P. Sahare* * Braintree, United Kingdom Objective: This main aim of the study was to nd the subtypes and co morbid conditions associated with ADHD among children and adolescents attending paediatric community clinic settings in a patch of Mid Essex.UK. The second aim was to nd out how is ADHD managed in the community setting. Method: Design: Cross sectional study with retrospective data analysis Place and Duration of study: Children and Adolescent attending community clinic setting in a patch of Midessex, UK from January to February 2010. Retrospective data analysis was done in January 2011. Methods: 4-19 years children and adolescents attending the community clinic in the Braintree and Witham patch of Midessex UK during the above mentioned period. Results: Of the 141 children attending the clinic 23 (16.3%) children had a diagnosis of combined type ADHD and 7 (4.9%) were diagnosed to have inattentive type of ADHD. The common co-morbid conditions associated with ADHD were Oppositional deant behaviour (n=12) (40%), emotional and behavioural difculties (n=5) (16.6%), sleep problems (n=5) (16.6%), learning difculty (n=8) (26.6%), motor coordination difculties (n=5) (16.6%), and anxiety (n=3) (10%). All the parents and teachers of children diagnosed with ADHD were provided behavioural strategies to be implemented at home and school respectively. Out of the 30 children with ADHD/ ADD spectrum 24(80%) children were started on medications (modied release preparation of methylphenidate). Desired response so as to reduce the core symptoms of ADHD was obtained in 20(83.3%) children. 7(23.3%) children were referred to the Child and Adolescent mental health team. 5 (16.6%) children had input from the Occupational therapy team. Melatonin was the drug of choice for children with sleep problems who did not respond to good bed time routines. Only 2(8.3%) children had weight loss as a side effect of medications. Conclusion: The results suggest that in Midessex patch of UK approach to management of ADHD is multimodal with involvement of children, parents, and other health professionals along with medications. Co morbidities are commonly associated with ADHD and hence there is a need to involve other health professionals. Modied release preparations of methylphenidate are effective in managing ADHD.

P-03-05 Bipolar disorder diagnostic among ADHD population use of child Bipolar Questionnaire (CBQ, Papolos, 2006) A.-L. Thoumy*, A. Gaiffas, M. P. Bouvard * Bordeaux, France Objective: An overlap of maniac and hypomaniac symptoms and ADHD symptoms is frequently described, particularly in children and adolescents. The main objective of this study is to evaluate maniac and hypomaniac symptoms presented by children and adolescents with ADHD using categorical, dimensional and temperamental approach. Method: A 12 months prospective study included 35 subjects with ADHD diagnostic, aged 7 to 17 years old. Maniac and hypomaniac symptoms were studied using different approaches: categorical (MINI-KID, ADHD Rating-Scale), dimensional (Child Behavior Checklist, Child Bipolar Questionnaire) and temperamental (Ques tionnaire de Temperament Cyclothymique et Hypersensitif). Results: According to dimensional approach, children and adolescents with ADHD present externalizing symptoms (aggressiveness, irritability, emotion dysregulation). Conclusion: Dimensional approach underlines a similar symptomatology for bipolar disorder (BPD) and ADHD. There is a particular group among this ADHD population, with irritability, poor frustration

P-03-07 Verbal turns difculties in 4-5 years old Saudi males with ADHD W. Al-Dakroury*, N. Hewlett, J. Watson, H. Gardner * Riyadh, Saudi Arabia Objective: This study will investigate the verbal turns difculties in of 4-5 years old males with Attention Decit Hyperactivity Disorder in Jeddah region, Saudi Arabia.

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109 Method: The participants were twenty 4-5 year old Saudi boys. Ten were typically developing and ten had a diagnosis of ADHD. All participants were mono lingual and from the Jeddah region of Saudi Arabia. Speech and Language screening and Hearing screening were conducted for all typically developing children. A 30 min sample of speech was collected from each child in conversation with an unfamiliar interlocutor. The protocol for each session was consistent across all participants. A 15 min sample of speech was collected during free play with the mother. All sessions were recorded on DVD using two video cameras. We intend to use this data for an extensive comparison of the pragmatic linguistic abilities of ADHD children and typically developing children. The rst stage of this analysis, reported here, focused on quantitative aspects of verbal output. Results: In the sessions with the unfamiliar interlocutor, the mean number of verbal turns for the ADHD group was 67.1 and for the typically developing children it was 196.9. The difference was signicant (p \ 0.0001). In the sessions with the mother, the mean number of verbal turns for the ADHD group was 47.2 and for the typically developing children it was 123.50. The difference was signicant (p \ 0.0001). In the sessions with the unfamiliar interlocutor, the mean number of words per turn for the ADHD group was 1.73 and for the typically developing children it was 2.74. The difference was signicant (p \ 0.001). In the sessions with the mother, the mean number of words per turn for the ADHD group was 1.954 and for the typically developing children it was 2.78. The difference was signicant (p \ 0.001). Conclusion: ADHD children have a reduced verbal turns, compared to typically developing children of similar age. Of course we have at this stage no means of telling whether the reduced verbal turns is merely a by-product of non-linguistic core behavioral characteristics of this disorder or whether it stems from a core linguistic pragmatic decit which is (or can be) an integral part of the disorder itself. The next stage of our research will involve an analysis of topic initiation and topic maintenance characteristics, within the same data set, with a view to throwing further light on this question. S and ADHD-RS scales). After adjustment for comorbidity, age, gender and symptom severity scores, ADHD patients with a CBCL-DP prole showed a personality pattern characterized by high Emotionality on the EAS questionnaire and low Self-directedness on the JTCI questionnaire. There was a trend toward an association between the CBCL-DP prole and response to methylphenidate (ADHD-RS Response rate: t-test = 1.80; p = 0.07). Subjects without the CBCL-DP prole showed a better response to methylphenidate treatment for most criteria responses (criteria 1: improvement on the ADHD-RS above 50%: chi2 test = 3.97; p\0.05 - criteria 2: improvement on the CGI-S above 50%: chi2 test = 1.43; p \ 0.23 - criteria 3: improvement on the ADHD-RS and CGI-S above 50%: chi2 test = 4.29; p\0.05). No signicant difference was found between subjects with and without CBCL-DP in cognitive functioning. Conclusion: Given the specic clinical characteristics and treatment outcomes of ADHD patients with a CBCL-DP prole, further research is needed to develop appropriate treatment strategies.

P-03-09 Reader proles in ADHD subtypes in 7-10 years old children in Malaga (Spain) M.-J. Diaz*, A. Lora-Espinosa, M. Lopez-Zamora, J. L. Luque-Vilaseca, N. Mendoza * Malaga, Spain Objective: 1) To study the efciency and reading speed in children with ADHD. 2) To study if the ADHD subtypes have different reader proles. 3) To establish how children with different subtypes of ADHD behave at reading. Method: Population: Children 7-8 and 9-10 years-old of Malaga (Spain): 28 and 48 Primary School. Multistage cluster random sampling: 14 schools: 52 classrooms: 1000 children were included. Sample: N=242: 79 children with ADHD (inattentive subtype=35, hyperactive-impulsive subtype=18 and combined subtype=26), 68 children with reading disability (RD) and 95 controls. Measures: academic performance, reading efciency, reading speed, lexical effect and inhibition decits. Method: 1) Questionnaires DSM-IVTR-ADHD for the diagnosis of ADHD; 2) Performance Vanderbilt to parents and teachers; 3) Reading Efciency Test for the diagnosis of reading disability; 4) Ravens Test to remove children with low IQ; and 5) Lexical Decision Task with 3 types of stimuli: words, nonwords and pseudohomophones, this task was programmed with E-Prime Software 1.2. Results: Low performance in reading (p\0.005): inattentive subtype: OR=7.52 (4.69-12.07), hyperactive-impulsive: OR=2.92 (1.48-5.76), combined: OR=7.40 (2.80-19.56). In children 9-10 years old in reading efciency: IA: 20.12 (SD=3.3, p\0.001), HI: 24.25 (SD=6.19, p\0.23), mean controls: 28.12 (SD=6.06). In reading speed: IA: 24 (SD=4.03, p\0.001), HI: 26.75 (SD=6.15, p\0.14), controls: 30.07 (SD=6.03). Reading time of words (p\0.000): IA=2239.47ms, HI=1729.67ms, RD=2431.91ms, controls= 1759.95ms. Reading time of pseudohomophones (p\0.000): IA= 3100.34ms, HI=2337.25ms, RD=2911.26ms, controls=2322.14ms. Conclusion: 1. High risk of low academic performance in children with ADHD (inattentive subtype [OR). 2. Reading efciency task: worst score of children with ADHD. The worst is the inattentive subtype, but better than children with reading disability because there is not phonological decit. 3. Subtype-HI almost the older normally achieving readers. 4. Inattentive and hyperactive-impulsive subtypes are different disorders.

P-03-08 Do ADHD children with a CBCL-Dysregulation prole have specic treatment outcomes, clinical and cognitive features? H. Peyre*, M. Speranza, D. Purper-Ouakil * Paris, France Objective: The CBCL-Dysregulation Prole, CBCL-DP, characterized by elevated scores on the Attention Problems, Aggressive behavior and Anxious/Depressed scales of the Child Behavior Checklist (CBCL) is associated with later severe psychopathology and psychosocial impairment. This study aims to identify the clinical characteristics (clinical severity, comorbidity, temperament and character traits), cognitive prole and treatment outcomes of Attention Decit Hyperactivity Disorder (ADHD) children with a CBCLDP prole. Method: The sample consisted of 173 outpatients (age mean = 10.9; age SD = 2.82; 153 males) with ADHD. A subsample of 136 subjects was reassessed with clinical (CGI-S and ADHD-RS) and neuropsychological tests (Trial Making Test, Stroop test and Continuous Performance Test) after optimal titration of methylphenidate treatment. Results: Subjects with a CBCL-DP prole (24.3% of the sample) showed more comorbidity (mainly oppositional deant disorders and anxiety disorders) and a higher clinical severity (p\0.01 for both CGI-

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Friday, 27 May 2011, 14.3016.00 P-04 Co-morbidity: Adults I

P-04-01 Adult Attention Decit Hyperactivity Disorder and obesity: A case-control study M. F. Docet*, A. Larranaga, J. L. Fernandez Sastre, L. F. Perez Mendez, R. V. Garca-Mayor * Vigo, Spain Objective: To determine the rate of Attention Decit Hyperactivity Disorder (ADHD) in obese adult patients in comparison with normal weight adults and its relationship with gender and obesity degree. Method: This case-control study includes 252 obese patients dened by a Body Mass Index (BMI)C30 kg/m2, with a mean age of 49.413.7 years, range 18-79 years, 203 (80.6%) women, and a mean BMI=40.35.9 kg/m2; and 172 normal weight subjects (BMI=18.524.9 kg/m2), with a mean age of 40.213.5 years, range 18-79 years, 124 (72.1%) women. Exclusion criteria: to have cognitive disorders and/or to be unable to perform the Self-Report Scale. Weight, height and BMI were determined in all the participants and they were categorized by their obesity degree. The screening version of the Adult ADHD Self-Report Scale Version-1.1 was administered to all the participants. Those who have four or more checkmarks were diagnosed as having ADHD. The study protocol was approved by the local ethical committee and all the subjects gave their informed consent. Results: Fifty-seven out of 252 (22.6%) obese patients and nine out of 172 (5.2%) normal weight subjects were diagnosed with ADHD (p=0.000; OR=5.3). There were not signicant differences related to gender in both obese and normal weight groups. The proportion of patients having ADHD in I, II and III obesity degrees was 8 out of 43 (18.6%), 24 out of 87 (27.6%), 25 out of 122 (20.5%), respectively, without statistically signicant differences among them (p=0.38). Conclusion: A high rate of ADHD was observed in the obese adult patients. ADHD patients are 5.3 times more likely to suffer from obesity than their non-ADHD counterparts. The impulsive and nonattentional behaviour of ADHD patients, may contribute to the development of abnormal eating behaviours leading to obesity.

P-03-10 Gender differences in internalized and externalized problems of children with ADHD I. Jerkovic*, R. Damjanovic, S. Golubovic * Novi Sad, Serbia Objective: Attention Decit Hyperactivity Disorder (ADHD) is not independent of the childs sex. The study analyzes the extent to which ADHD boys and girls differ in their expression of internalized and externalized problems, as well as in terms of the problems with attention and hyperactivity/impulsivity. Method: The sample consisted of 1079 children of the average age 91.60 months (SD=10.67). Assessors were pre-school teachers in the kindergartens and teachers in early grades of primary school. By using the scale IVJER, it has been determined that 184 children meet the criteria for ADHD (17.0% of the total sample). Out of 184 distinguished children in total, there were 132 boys (71.7%) and 52 girls (28.3%). Results: Based on Chi-square test (Chi-Square=10.072, p\.01), it has been conrmed that girls are relatively more frequently represented in a group of children who have difculties with attention, while boys are more frequently represented in a group that meets the criteria for the mixed type of disorders. When comparing the scores (and not just their afliation to a specic diagnostic subgroup) a difference between boys and girls on the IVJER scale is even more obvious. Boys are underrated both in relation to the scores for attention (t=2.34, p=.02) and in relation to the scores for hyperactivity/impulsivity (t=2.74, p\.01). Afterwards, all distinguished children have been assessed on the ECBI (The Eyberg Child Behaviour Inventory) and SCARED (Screen for Child Anxiety Related Disorders) scales. Conclusion: According to the results of t-test we can conclude that girls with ADHD have shown more indicators of panic disorder (t=3.70, p\.01) and of social anxiety (t=4.09, p\.01) than boys with ADHD, while there is no difference in the manifestation of separation anxiety symptoms, generalized anxiety disorder and school phobia. In terms of externalized problems, there was no difference in this sample.

P-04-02 The inuence of ADHD phenotype on screening for Dyslexia A. Duguid*, U. Muller * Cambridge, United Kingdom Objective: Patients suffering from ADHD often have comorbid neurodevelopmental disorders, including learning disabilities. Accurately diagnosing the co-occurring conditions can be challenging due to overlapping clinical features. This is certainly true for developmental dyslexia: in fact, the similarity in features and high cooccurrence with ADHD has prompted the suggestion of a common aetiology (Eden, 2008). The present study aims to determine if the

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111 characteristics of a patients ADHD phenotype can inuence the outcomes of a widely used dyslexia screener in an adult population. Method: All patients were assessed at the Adult ADHD Research Clinic, Cambridge, using a semi-structured clinical interview. 98 consecutive patients (age 18-52 years; 33 female, 65 male) were diagnosed with ADHD according to DSM-IV criteria and included into this study. The 18-question ASRS (Kessler 2005) was used to rate symptom severity and to classify the diagnostic subtype (inattentive or hyperactive). The Revised Adult Dyslexia Checklist (RADC; Vinegrad 1994) was used as a dyslexia screener. This 20-item questionnaire contains 12 specic and 8 non-specic questions relating to dyslexia. Correlations between scores and sub-scores from the ASRS and the dyslexia screener were calculated in order to investigate the hypothesis that attention decits, but not hyperactivity/ impulsivity symptoms, mimic dyslexia symptoms in adults with ADHD. Results: Analysis using Pearsons product-moment correlation coefcients showed there was a positive correlation between the inattentive ASRS score and the non-specic RADC score (r = 0.270, p = 0.007) but not between the hyperactive ASRS score and nonspecic RADC score. Analysis of individual questions in the ASRS identied questions when answered positively predicted positive answers in certain questions in the dyslexia screener. Conclusion: Discovery of an association between inattentive features of ADHD and dyslexia in clinical tests may alter the way clinicians use dyslexia screeners in adult ADHD populations. Specically, identication of questions in the ASRS and dyslexia screener which indicate an overlap in clinical features may guide the interpretation and diagnosis of dyslexia in those adult ADHD patients. For screening purposes in ADHD patients it may be more appropriate to use only the 12 dyslexia-specic questions from the RADC and disregard the non-specic questions. Conclusion: The present cross-sectional study carried out in a treatment seeking SUD population demonstrates high prevalence rates of adult ADHD consistent with other recent estimates of ADHD prevalence in SUD populations. The ASRS can be useful as a screening instrument in this population but a thorough clinical assessment is needed for correct diagnosis. Further analysis will show if this population also displays high co-occurrence with other psychiatric disorders, such as depression. .

P-04-04 The possible role of childhood ADHD in the development of adult heroin dependence C. Barta*, A. Szilagyi, K. Boor, A. Szekely, Z. Demetrovics, J. Csorba, M. Sasvari-Szekely * Budapest, Hungary Objective: Several studies suggested a possible link between substance use disorder and Attention Decit Hyperactivity Disorder (ADHD). The goal of the study was to analyze this link. Method: The ADHD Rating Scale (ADHD-RS) completed by parents is a tool for diagnosing ADHD in childhood. We adapted this questionnaire for a self-report retrospective scale to estimate the presence of childhood ADHD symptoms in adults. This retrospective questionnaire was completed by 121 heroin dependent patients and 85 age- and sex-matched healthy controls. Results: Our results showed strong gender difference in the prevalence of ADHD symptoms, since male subjects obtained higher mean scores on both attention-decit and hyperactivity scales than females in both the control as well as in the heroin dependent population. Besides, the mean scores of both scales were higher in the clinical population as a higher portion of substance abusers reported symptoms of childhood ADHD than controls. Conclusion: These results support the hypothesis that untreated childhood ADHD could be a risk factor for developing substance use disorder.

P-04-03 ADHD in treatment seeking patients with substance use disorders: prevalence and usefulness of the Adult ADHD SelfReport Scale (ASRS) as a screener M. Konstenius*, S. Wallhed, G. van de Glind, W. van den Brink, J. Franck * Stockholm, Sweden Objective: Attention Decit Hyperactivity Disorder (ADHD), with or without conduct disorder, is a risk factor for developing substance use disorders. Prior studies on ADHD in populations with substance use disorders (SUD) have shown prevalence rates between 10% and 30%. Method: This report is part of a larger international cross-sectional study with a two-stage design, consisting of two parts: (1) screening for ADHD with self-rated ADHD-symptoms using the Adult ADHD Self-Report Scale (ASRS), and (2) a diagnostic assessment using the Connors Adult ADHD Diagnostic Interview for DSM-IV (CAADID). At this time, we have recruited 307 consecutive patients at a large publicly funded addiction treatment clinic in Stockholm, Sweden. Of these 307 patients, 146 completed the full diagnostic assessment. Results: Twenty-three percent of the sample met DSM-IV diagnostic criteria for adult ADHD. With regards to SUD, 70% of the sample reported primary alcohol dependence, 22% primary dependence of narcotics such as amphetamines or opioids, and 8% a primary diagnosis of cannabis dependence. ASRS sensitivity was 0.82 (95% CI 0.66-0.91), specicity 0.76 (95% CI 0.68-0.83) with a positive predictive value of 0.50 (95% CI 0.37-0.63) and a negative predictive value of 0.94 (CI 0.87-0.97).

P-04-05 Association of atomoxetine treatment with substance use and abuse in a drug using population with Attention Decit Hyperactivity Disorder I. Petrakis*, G. Dermatis * Limnos, Greece Objective: The basis for this study was the well-established association between ADHD and substance use disorder. The aim was to investigate the effects of atomoxetine on the illicit drug use of opiates, benzodiazepines, cannabis and cocaine in drug dependent individuals attending substitution therapy treatment at the Greek Organisation Against Drugs.The objectives were to compare urine sample results for opioid, cannabis, cocaine and benzodiazepines three months before and three months after the initiation of atomoxetine treatment and to monitor for dosage changes of methadone and buprenorphine after the initiation of atomoxetine. Method: Fourteen patients (9 male and 5 female) completed a 24-week open-label study. Urine drug testing results were monitored for a period of three months before and three months after the initiation of atomoxetine treatment in order to determine any changes in drug use behaviour. Compliance to treatment and changes in methadone or buprenorphine doses were also monitored. Results: No statistically signicant differences were identied between the mean results of the two monitoring periods (pairedsamples t test) for any of the screened drugs of abuse. However, the overall mean urine results for opioids, cocaine and benzodiazepines showed a trend towards reduction after the introduction of

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112 atomoxetine. The post-atomoxetine grouped mean urine results for cannabis were found higher than the results prior to initiating the ADHD pharmacotherapy. Supervision of atomoxetine administration showed no added benet when compared to non-supervised administration. No notable changes in methadone or buprenorphine doses were observed throughout the monitoring period. Conclusion: This study investigated the effects of atomoxetine on all four screened drug substances in one of the OKANA drug dependency centres. The ndings of this study suggest that a larger scale randomised placebo-controlled study is needed in order to investigate the efcacy of atomoxetine as adjuvant treatment to opiate substitutes. months we have worked with 2 young people with this complex presentation. Our impression was that compared to other journeys within the care and social care system, these young people with their babies experience a particularly haphazard and chaotic journey through the organisational systems. Method: We have reviewed the literature concerning teenage pregnancy and co-existing mental health disorders, including substance misuse. The study, as a multiple case design, then explores two cases in detail from a systemic perspective. We have described at the individual pathways through the health and social care organisational systems from the young persons experience. We have tracked the treatment pathways of substance misuse treatment and treatment for ADHD through that process. We have also explored the organisational structure and the points at which decisions are made about the care and parenting for the baby. We have assessed the parent-infant relationship using The Care Index and The working Model of the Child Interview. Results: The exploration of the case study data has then generated hypotheses about treatment and treatment outcomes for this group. This study demonstrates that recognition and treatment of ADHD and substance misuse problems during pregnancy adds signicantly to the complexity of this process for young people. Conclusion: The study proposes that stability of treatment, including psychosocial interventions, both before and after birth is likely to improve the establishment of early attachment relationships for young mothers and their babies. The combined risk factors for early parenthood include ADHD, school exclusion, childhood maltreatment and social adversity, which are all factors associated with substance misuse disorders in adolescence. This group requires further study in order to compare treatment interventions and develop services that will promote improved infant outcomes.

P-04-06 ADHD and substance abuse: Could sensation seeking be a moderating factor? A. Burke* * Johannesburke, South Africa Objective: The argument presented in this paper rests on three fundamental issues, i.e.: Research has shown that in adults, symptoms of hyperactivity become less pronounced, and instead inattention and disinhibition become most prominent (Billingsley-Jackson, 2008). Adults with ADHD actively engage in risky behaviours, such as substance abuse and sensation seeking (Huizink, van Lier & Crijnen, 2008; Peters & McMahon, 1996; Triolo, 1999; Wood, Wendor & Reimherr, 1983). Sensation seeking, together with other factors, are signicant predictors of substance abuse Wagner (2000). Many research studies report a linear causal link between ADHD and Substance Use, or a linear causal link between Sensation Seeking and Substance Abuse. The objective of this study is to create a multifactorial model of ADHD and Substance Abuse. Method: The results of various exploratory, quasi-experimental and experimental studies will be integrated into a meta-theoretical model. This research has been done on 50 low sensation seekers, 50 high sensation seekers, 15 ADHD, and 20 non-ADHD adults. These groups have further been subdivided into Substance and non-Substance abusers. The following instruments have been used: Biopac EEG, CANTAB, Zuckerman Sensation Seeking Scale (Form V), Arnet Inventory of Sensation Seeking, ASRS. Multivariate statistical techniques, such as factor Analysis, Multiple regression Analysis and Structural Equation Modeling is used to analyze the data. Results: The results indicate that there is a complex relationship between ADHD and Sensation Seeking, with Sensation Seeking being a moderating factor in the frequency and type of substances that are used by ADHD. The model also suggests that overt and covert effects of a substance may lead to dependence on the substance. Conclusion: The results seem to suggest that treatment of adults with ADHD and a comorbid Substance Abuse problem would have to take various factors into account for a successful outcome.

P-04-08 Internet addiction in male adolescents with untreated ADHD - rst results of an out-patient diagnostic and treatment program in Berlin O. Bilke-Hentsch*, T. Hellenschmidt * Berlin, Germany Objective: Media and Internet addiction seem to emerge as a mental health problem in adolescents with ADHD. Although not yet broadly recognised by addiction research, there exist clinical and neurobiological implications, that Internet addiction resembles classical adolescent addiction patterns such as with marihuana or alcohol. ADHD patients are supposed to be a risk group. Method: As part of either the dependency or of the out-patient psychotherapy programs in a large mental hospital covering inner-city Berlin an out-patient diagnostic and treatment system was established in April 2009 for internet addicted youth. Using ICD-10, operationalised psychodynamic diagnostics (OPD-KJ) and family diagnostic procedures specic patterns of intrapsychic conicts and family developmental stages as well as ADHD features should be detected. Results: From 4-9/2009 we could administer 27 severe male Internet addiction-cases with all signs of clinical dependency, both neuropsychological and somatic, including withdrawal, severe craving and severe mood swings as well as massive social and academic failure. 9 patients showed classical signs of an untreated ADHD such as impulsivity, short attention span and failure in school, apart from their other psychiatric disorders and chronic family conicts. Conclusion: There seems to be a small but severely ill subgroup of intensive internet users that develop social isolation, craving and other features of addiction. Using the clinical diagnosis Internet addiction offering an out-patient approach we must consider severe chronic intrapsychic conicts as well as untreated ADHD and other

P-04-07 Teenage pregnancy, ADHD and co-existing substance misuse disorders; a review and exploration of 2 case studies D. Judge*, S. Gracias * Bristol, United Kingdom Objective: The Young Peoples Specialist Substance Misuse Treatment Service was established in 2000 to work with Adolescents in Bristol with complex drug treatment needs. Over the last 10 years the service has seen a steady increase in presentations of young people at various stages of pregnancy with co-existing substance misuse and a range of mental health disorders including ADHD. During the last 6

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113 psychiatric disorders for therapy planning. Obviously intense research as well in epidemiology as in clinical treatment is needed in this worldwide broadening area. the current analysis were the Addiction Severity Index (ASI), ADHD Retrospective Questionnaire, Perceived Stress Scale (PSS), and Methadone Treatment Interview. Results: (1) As a mediate indicator for the severity of addiction, we found signicant differences in physical withdrawal symptoms (Methadone Treatment Interview) between the subgroups of expected and non-expected childhood ADHD using the plausability of childhood hyperactivity as a grouping variable. Patients with expected childhood hyperactivity showed signicantly (p=0,024) higher group mean on the subscale of physical withdrawal symptoms. (2) The main indicator for treatment efcacy was the length of time the patients spent in treatment. The results of linear regression showed that the signicant explanatory variables of the treatment length were perceived stress (Beta=0,349, p=0,004) and the total score of the ADHD Retrospective Questionnaire (Beta= -0,256, p=0,032). Conclusion: Our study may reafrm the importance of early recognition of ADHD for it has a signicant impact on some aspects of addiction severity (such as the physical withdrawal symptoms) and on the treatment efcacy of substance use disorders. We also need to be aware of the different effects of hyperactivity and attention decit subtypes.

P-04-09 The impact of childhood ADHD on the severity of addiction, and on subsequent SUD treatment efcacy M. Kapitany-Foveny*, Z. Demetrovics * Budapest, Hungary Objective: The main goal of the study was to analyze the (1) ADHDs effect on the severity of addiction, and (2) the possible moderating effect of ADHD on the treatment efcacy of substance use disorders.

P-04-10 Substance use disorder with comorbid Attention Decit Hyperactivity Disorder Y.-A. Kaufmann*, J.-G. Bavarel, R. Khan, D. Zullino ` * Geneve, Switzerland Objective: Attention Decit Hyperactivity Disorder (ADHD) affects not only children but persists for up to 4.4% in the general population. One of the most problematic risk factors for untreated children in adolescents and in adulthood is substance use disorder (SUD). Often undiagnosed, however a few studies show, depending on the substance used, 15 to 35% adult SUD patients suffer from ADHD. This study was designed to evaluate the prevalence of ADHD in a French speaking Swiss SUD facility. Method: It consisted of 97 adult participants examined for ADHD. We used in this cross sectional study WHO self-report screening scale for ADHD (ASRS-v1.1). For all subjects with at least 4 positives of 6 items on the ASRS-v1.1 the diagnosis of ADHD in childhood was then conrmed with the Wender Utah rating scale (WURS). Results: First we found that 39% had at least 4 of the 6 items positive in the ASRS-v1.1 test. Among this group of subjects positive for the screening of ADHD no more than 34% suffered from ADHD in their childhood hence excluding false positives by the WURS. Conclusion: The results of this study conrm the high rate of ADHD patients in SUD units mentioned in other studies. Using WURS seems more accurate to conrm the diagnosis of ADHD in SUD patient. However, family interview or the use of the adult Conners scale not yet available in French should provide an even more robust ADHD diagnosis. Thus it will ease decision making for instauring a treatment.

Method: Two samples have been involved in the analysis. The rst sample consisted of 80 heroin dependent patients (55 males and 35 females, mean age = 30,2 years, sd=5,48) participating in the rst Suboxone maintenance treatment trial at six outpatient centers in Hungary. The second sample consisted of 73 heroin dependent patients (52 males and 21 females, mean age= 26,7 years, sd=5) who entered methadone maintenance treatment at the biggest Drug Oupatient Centre in Budapest, Hungary. The applied measures used in

P-04-11 Screening for ADHD among patients with SUD in the MMT Programme in Malaysia: A new avenue for SUD treatment H. Peters* * Kajang, Malaysia Objective: The study aims to explore the prevalence and degree of ADHD related symptoms among patients in the MMT program in Malaysia. The ongoing pilot study wants to illustrate the moderating

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114 effect of comorbid ADHD symptoms on SUD to broaden understanding, planning and treatment of addiction. Method: The pilot study screened a sample of 20 patients from the University Hospital UMCAS with the diagnosis of SUD who taking part in the MMT Programme in Kuala Lumpur in Malaysia. Among these patients, the attention prole was evaluated with a translation of the ADHD-LE from Schmidt and al. 2009. Results: A signicantly impaired adaptive functional attention prole was found in over 80% of the clinical group. These outcomes are associated with an early onset of addiction, a long substance dependence, an increased relapse frequency and a higher rate of comorbid psychological problems. Additionally, a signicant part of the sample has an increased number of accidents which are mostly caused by own fault. The age of onset is corresponding with difculties in the functional attention organisation. Conclusion: The results recommend to increase awareness of the status of ADHD as the key initiating factor for SUD. Poor treatment outcomes in the MMT program should be considered alongside the potential moderating impact of untreated ADHD. It is important to look at the individuals developmental relationship between attention decit/hyperactivity symptoms and substance abuse in light of self medication. This could greatly improve treatment outcomes. The ADHD-LE screening is an excellent reliable and economic tool to illustrate the relevance of functional impaired attention among SUD patients. It provides valuable information for clinical decision making in view of administering adjunct treatment of Methylphenidate. were younger, had earlier onset of regular substance use, and had greater likelihood of drug addiction than the non-ADHD cohort. Outcome data do not suggest higher relapse rates in the ADHD cohort.

P-04-13 Association between Attention Decit Hyperactivity Disorder (ADHD) and craving among patients with Alcohol Use Disorders (AUD) A. Seitz*, P. Allemann, H. Klingemann, P. Eggli, Y. Burren, M. Wapp, K. Schlai, S. Stutz, C. Buri, F. Moggi, I. Icasa * Bern, Switzerland Objective: Craving is a crucial concept in diagnosis, etiology and treatment of AUD. Clinical experiences give rise to the suspicion that patients with AUD and ADHD may suffer more from craving than AUD only patients. The purpose of this study is to examine the association between ADHD and craving among patients who enter an inpatient treatment for AUD. Method: In the International ADHD in Substance use disorders Prevalence study (IASP) of the International Collaboration on ADHD and Substance Abuse (ICASA), substance use disorder treatment programs of nine European countries, the USA, South Africa and Australia are collecting data on ADHD and comorbid disorders. In the Swiss IASP study, 400 patients in three inpatient treatment programs were assessed by the Adult ADHD Self-Report Scale (ASRS), the Obsessive Compulsive Drinking Scale (OCDS), the Screening for Substance Use Disorders (SSUD), the Screening for Symptoms of Withdrawal (SSW) and the Brief Symptom Inventory (BSI). AUD patients with and without ADHD were compared on craving, withdrawal and psychiatric symptoms by using chi-squared for categorical data and t-test for continuous data. The association of craving and ADHD as well as the most important withdrawal and psychiatric symptoms were analyzed by hierarchical regression analyses. Results: Patients with adult ADHD showed higher craving and more withdrawal and psychiatric symptoms than patients without ADHD. They also rated withdrawal symptoms as more severe. In the regression model, about 40% of variance in alcohol craving can be explained by ADHD but more strongly by withdrawal symptoms (i.e., anxiety/agitation, sweating and gastrointestinal symptoms) and psychiatric symptoms (i.e., depression, obsessive-compulsive behavior and interpersonal sensitivity). Conclusion: Alcohol craving is more likely related to subjective rating of withdrawal and psychiatric symptoms than to adult ADHD. The validity of the ASRS, however, needs to be further examined by the large data set of the IASP study of ICASA.

P-04-12 ADHD and addictions: Clinical characteristics and outcome in a residential treatment population T. Schneekloth*, A. Rai, D. Hall-Flavin, V. Karpyak, L. Loukianova, J. Geske, J. Biernacka, M. Frye, D. Mrazek * Rochester, Minnesota, USA Objective: ADHD is a highly prevalent childhood disorder with symptoms persisting into adulthood at reported prevalence of 4.4% in United States. The comorbidity of ADHD and Substance Use Disorders (SUDs) has been well established. Several studies of subjects with SUDs suggest that 15-25% of adults referred for treatment have a history or active symptoms of ADHD. ADHD has been associated with earlier onset of SUDs and greater treatment resistance. The aim of this study was to characterize the ADHD cohort in an addiction treatment program and examine the impact of this comorbidity on addiction outcome. Method: This was a retrospective study of 853 patients admitted to residential level addiction treatment between 6/28/2004 and 1/28/ 2011 in Rochester, Minnesota, USA. Approximately 75% of these patients had non-psychotic psychiatric disorders comorbid with SUDs. A clinical database, including discharge diagnoses and followup outcome data, was analyzed utilizing Chi-squared tests for association of ADHD with relapse, drug diagnosis, and pre-admission alcohol use. Differences in distributions of age and consumption measures between patients with and without ADHD were tested using Wilcoxon rank sum scores. Results: Fifty-six of 853 patients (6.6%) had a clinical diagnosis of ADHD. Patients with ADHD were signicantly younger (p\.0001) and began regular use at a younger age (p=0.0004). They were also more likely to have a drug addiction diagnosis (p=0.0001). Pretreatment alcohol consumption patterns and post-treatment relapse rates at 3, 6 and 12 months did not differ signicantly between the groups. Conclusion: This study showed lower than expected incidence of ADHD in an addiction treatment population, an incidence similar to community rates. Consistent with earlier reports, those with ADHD

P-04-14 Validation research of modied Lesch Alcoholic Typology including group of alcohol addicted patients with co morbid ADHD spectrum disorders S. Syrek*, M. Sznabowicz * Borlange, Sweden Objective: Completing classication of alcohol addiction with group of patients with ADHD. Method: The coexistence of ADHD and addiction including alcoholism was being observed and described for more than 40 years. Despite that ADHD spectrum comorbidity has not been taken into consideration in alcohol addiction classications. Lesch Alcoholic Typology (LAT) published in 1988 and used by the authors distinguishes 4 subgroups of patients addicted to alcohol. Out of previous classications it is the only one of clinical use, points out directly

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115 etiology of addiction and includes therapeutic instructions that consider comorbidity of mental disorders. In separate article we propose the addendum to the above mentioned classication in order to consider the group of patients with ADHD and modify the diagnostic procedure. Craving in the V-th (ADHD) group appears to cope impulsivity, hyperactivity and attention decits. Alcoholism model is described by Reward Deciency Syndrome. We present revised alcoholic typology and research plan which would verify our thesis about existence of 5 homogenous groups with different addiction etiology and specic treatment. The evaluation will cover verication of diagnostic procedure and distribution of patients in subgroups distinguished with regard to diagnostic questions and clinical scales. Conclusion: Since therapeutic approaches vary signicantly between subgroups of alcohol-dependent patients a proper classication seems to be of high clinical relevance. disorders and ADHD. Those studies on allergic rhinitis and asthma returned inconsistent results, while atopic eczema (AE) had not been adequately accounted for. Method: We here present our recent epidemiological studies on the association between ADHD and AE and outline current investigations to further elucidate the underlying neurobiological mechanisms. Results: ADHD was signicantly associated to AE (odds ratios around 1.5) in two epidemiological cross-sectional and in two epidemiological birth-cohort samples. The association was independent of comorbid atopic disorders, socio-economic factors and various other possible confounders, but possibly modied by early sleep disruption. Even when AE did not persist beyond age 2 years the risk to develop ADHD was signicantly increased at age 10 y. Conclusion: The temporal pattern suggests that AE precedes and may cause or exacerbate ADHD symptoms. Both genetic as well as environmental factors may engender the association. Genetic studies as well as clinical trials are ongoing aiming to disentangle the complex aetiological relationship between biological disposition and psycho-neuro-immunological factors.

P-04-16 Impulsiveness and TCI traits in amphetamine and multisubstance depended patients - preliminary report M. Sznabowicz*, S. Syrek, J. Iskra, B. Karakiewicz * Szczecin, Poland Objective: The aim of the study was to examine associations between impulsiveness and personality traits in a group of patients with substance use disorder (SUD). Method: In the trial has been recruited 69 patients with SUD from a several psychiatric inpatient centers in Poland. Studied sample consisted of 34 amphetamine addicted subjects and 35 patients with multisubstance dependence. Patients were investigated using Barrat Impulsiveness Scale, The Temperament and Character Inventory (TCI) and clinical interview based on SSAGA questionnaire. Results: We did not detect correlation between impulsiveness and age in studied group. In a group of multisubstance dependant impulsiveness was not associated with risky behaviors in contrast to amphetamine addicted patients. Women with high impulsiveness had tendency to risky behaviors and high HA scores which was not observed in man. Signicant correlations were found in the whole group between impulsiveness and TCI scores: NS, HA and in subscales NS2, NS3, NS4 and HA4. Impulsiveness was inversely correlated with TCI scores in P, C, SD and subscales C3, SD1, SD2, SD3, SD5. Multisubstance addicted patients displayed higher Impulsiveness than amphetamine addicts while the opposite pattern was noted in Cooperativeness. In the studied group correlation between age and impulsiveness score has not been observed. Conclusion: In SUD patients high impulsiveness corresponds with temperamental traits related to extravagance, disorderliness and fatigability while character traits in impulsive patients mostly feature lack of purpose, irresponsibility and unhelpfulness.

P-05-02 Accidents and Attention Decit Hyperactivity Disorder in 6-14-year-old schoolchildren in Andalusia (Spain) A. Lora-Espinosa*, M. J. Diaz-Aguilar, J. Murcia, M. Montes, N. Martinez, M. I. Vazquez, A. Prosper, J. Barea, R. Hergueta, R. Jimenez, N. Mendoza * Malaga, Spain Objective: To determine prevalence-characteristics of accidents and relationship with DSM-IV-R-ADHD from 6 to 14 year-old children in Andalusia (Spain). Determine vulnerability among subtypes. This research is part of the Comprehensive Plan of Care for Accident Andalusia 2007-2012. Method: Target population: primary and secondary school students ages 6 to 14= 686332 children; centres= 2493. Multistage cluster sampling centres= 74. 1732 children were included. Measures: Sociodemographic, accidents: types, frequency, hospital, academic and social performance. Method: Questionnaires DSM-IV-TR-ADHD and performance Vanderbilt parents-and-teachers, survey-accidents, interview and medical examination. Results: N=1732, 828 children (48.42%) had 1586 accidents, mean= 1.90 (1.42), range=1-13. Open-wounds=28.56%, burns=11.26%, fractures=10.44%, dental-break=9.07%, choking=3.63%, bicyclefall=3,51%, near-drowning=2.1%, poisoning=1.7%. M=51.04%, F=48.95%. Male gender OR=1.85 (1.51-2.27). C3 accidents male gender OR=2.39 (1.71-3.33) p\0.001. 53.04% injured are children of parents without completing primary education versus 46.96% children of parents with high school, the relationship being statistically signicant for bicycle-fall (p\0.001), fractures and open-wounds (p\0.05). Meet DSM-IV ADHD-TR-210, male gender OR=1.6 (1.222.10). Accident for ADHD OR children=1.91 (1.42-2.57), inattentive subtype=1.46 (0.95-2.25), hyperactive=2.18 (1.25-3.82), combined=2.10 (1.24-3.54). OR increases to higher number of accidents: 1-accident ADHD=1.15 (0.78-1.69), 2-accidents=2.17 (1.40-3.36), 3-accidents=3.93 (2,64-5,85). Conclusion: The male is dominant in all types of accidents, frequency and intensity. There is a higher risk of accidents in ADHD children and any of the subtypes. The association between ADHDaccidents is greater, increasing his number. There is an association between parents education and children injuries.

Friday, 27 May 2011, 14.3016.00 P-05 Epidemiology: Children and adolescents I

P-05-01 ADHD is associated to atopic eczema M. Romanos*, A. Buske-Kirschbaum, V. Rossner, S. Weidinger, J. Schmitt * Munchen, Germany Objective: During the last decades various efforts have been undertaken to elucidate the hypothesis of an association between atopic

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P-05-03 The impact of coexisting mental health conditions on the cost of health service provision for children and adolescents with and without Attention Decit Hyperactivity Disorder (ADHD) in Germany M. Schlander*, O. Schwarz, G.-E. Trott, M. Viapiano, N. Bonauer, W. Scheller * Wiesbaden, Germany Objective: Coexisting mental health disorders are common in patients with ADHD and may increase utilization of health care services. The present study addresses the impact of comorbidities on the direct medical costs from the perspective of German Statutory Health Insurance (SHI) for patients with and without ADHD. Method: For a retrospective matched cohort study, concomitant diagnoses and health care resource utilization data for patients age 7 to 19 years with a diagnosis of ADHD (F90.0 and/or F90.1) and for a randomly selected control group (matched 1:1 by age and gender) were extracted from the Nordbaden claims database (year 2003), and were combined with SHI prescription data. Complete datasets were available for 2,171 children age 7-12 years and 768 adolescents age 13-19 years with a diagnosis of ADHD, plus the same number of control persons. Resource use was valued applying SHI acquisition costs. Patient subgroups were dened by the presence of conduct and personality disorders, mood and affective disorders, specic development disorders, and adjustment disorder. Results: Average costs per patient with ADHD were 622/661 (children/adolescents) compared to 245/250 for controls. ADHD

with coexisting conditions caused the following direct medical expenditures: in the additional presence of conduct and personality disorder, 703/769; mood and affective disorders, 714/761; specic development disorders, 630/766; adjustment disorder, 829/ 963. Costs for patients with the mental health disorders mentioned were also substantially increased in the absence of ADHD and will be presented in detail. Conclusion: The present data provide, for the rst time, insight into the profound impact of coexisting conditions on the nancial burden associated with a diagnosis of ADHD.

P-05-04 ADHD co-morbidity of child and juvenile sex offenders C. Cangin*, P. Taylor * Ludlow, USA Objective: To investigate ADHD prevalence, disorders co-morbidity, recidivism of 110 juvenile sex offenders JSO (age 5-17, age mean=12, SD =2.8). Method: In-person interviews, clinical assessments, judicial records of JSO Results: Over 81.8% of JSO have ADHD. All Autism, Bipolar, Intermittent Explosive Disorder, major depression, Pervasive Developmental Disorder (PDD), and Schizophrenia cases have comorbid hyperactive ADHD. All dysthmic and social phobia cases have comorbid inattentive ADHD. All Depressive disorder cases are

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comorbid with inattentive or mixed ADHD. All mood Disorder and Impulse Control Disorder (ICD) cases have comorbid inattentive or hyperactive ADHD. Most Posttraumatic stress disorder (PTSD), oppositional deant disorder (ODD), Conduct Disorder, adjustment disorder, anxiety phobia, paraphilia-related disorder, and psychosis cases are comorbid with ADHD. The most severe combinatorial sexual penetration offenses (anal, combined oral-anal, combined oralvaginal penetration offenses) are committed by JSO diagnosed with either mixed or hyperactive ADHD. While 15 of 110 JSO recidivated, 12 of them have ADHD (10 hyperactive, 1 inattentive, 1 mixed ADHD). None of the juveniles with Major depression, PTSD, ODD, ICD, social phobia, Schizophrenia, Pervasive Developmental Disorders recidivated. Substance abuse associate with ADHD but substance abuse alone has low correlation with recidivism. Recidivism rates of JSO on medications (Adderall Dextroamphetamine Amphetamine, Clonidine, Concerta Methylphenidate) are 15%, 28%, 27%, respectively, all of which are higher than the recidivism rate(12.6%) of juveniles not on such ADHD medications. Cluster analysis reveals 3 groups: (1) Non-recidivated cluster with ADHD, (2) Non-recidivated cluster without ADHD, and (3) recidivated cluster mostly with ADHD. There are 77 juveniles in Non-recidivated cluster with ADHD (44 hyperactive, 14 mixed, 19 inattentive), 18 juveniles in Non-recidivated cluster without ADHD, and 15 juveniles in recidivated cluster. Conclusion: Among JSO, ADHD is prevalent and many disorders coexist with ADHD. JSO on ADHD Medications (Adderall Dextroamphetamine Amphetamine, Clonidine, Concerta Methylphenidate) have higher recidivism rates than JSO not on such ADHD Medications.

Delay of Gratication Task and a Choice Delay Task. Furthermore, we measured attention, language comprehension, and early academic skills in the domain of Quantity-Number Competencies. Results: There are interrelations between the measures of inhibition and self-regulation. The Motoric Stroop Task explains 50% of variance in Quantity-Number Competencies (see Table 1). A second regression shows that when simultaneously entering mistakes in the Test of Attention and Language Comprehension in the regression they predict 40% of variance in Quantity-Number Competencies, with both predictors making independent signicant contributions (see Table 1). At this age parental ADHD ratings are not related to Inhibition Tasks. Conclusion: Measures of inhibition seem helpful for the prediction of early academic skills, but in addition language comprehension should be taken into account. This study is planned as a longitudinal study with a sample of 80 children, a second time of measurement in kindergarten and a third time of measurement at the end of rst grade. The aim is to identify risk factors for an ADHD diagnosis early to provide affected children with treatment before school enrolment.

P-05-05 Measures of inhibition support the prediction of early academic skills J. Merkt*, C. Gawrilow * Frankfurt, Germany Objective: Children with ADHD show decits in executive functions with a core decit in inhibition (Barkley, 1997; Gawrilow & Gollwitzer, 2008) and self-regulation (Gawrilow, Gollwitzer & Oettingen; in press) inducing massive problems in academic achievement (DuPaul & Stoner, 2003). This study aims at identifying the interrelations between different measures of inhibition, self-regulation, early academic skills, and ADHD symptoms in kindergarten. Method: Thirty-four unselected children (M-age = 5.6 years, SD = 0.4; 18 girls) participated during their last year of kindergarten. We assessed inhibition with a Go/No-Go Task and two Stroop-like Tasks (i.e., one verbal, one motoric) and self-regulation with a computerized P-05-06 Children suspected to have ADHD suffer from family dysfunction instead either as sole diagnosis or as a co-morbidity A. Schmidt*, E. Paiva Ayres, C. Brandalise Antoniazzi, C. Hilgert, F. Mugnol, F. Driemeier, F. Dartora, D. Pianetti, J. Fries * Porto Alegre, Brazil Objective: The experience and statistics of an interdisciplinary team in Southern Brazil. COE (Student Guidance Center) from Porto Alegre, in Southern Brazil, is an interdisciplinary team prepared to assess and to precisely diagnose learning difculties from most etiologies. Method: Amongst 114 students from 6 to 18 years old assessed in 2009 and 2010, COE received 63 children and adolescents referred

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118 because of a suspicion that they could have ADHD. This number is expectable if one considers that COE is a recognized reference to ADHD diagnosis and treatment. Results: After evaluation, we have identied ADHD in 28.57% of the 63-student sample; 55.47% had other diagnose and 15.87% had no pathology. However, we noticed another remarkable fact: 17 (29.98%) children and adolescents of the sample suffered the psychological consequences of some family dysfunction either as a comorbidity to a specic diagnosed disorder (9 children/17.29%) or as a reaction consisting of anxiety and stress itself, with no pathology associated (8 children/12.69%). In this last group of 8 children, adjustment distress due to family dysfunction emulated some ADHD symptoms, explaining mis-diagnose done by referring professionals. Conclusion: This work also describes our statistics regarding the other neuropsychiatric disorders found to be associated with ADHDsuspected students referred to us. We want to share them to be compared to data found worldwide and enhance further research on ADHD and its co-morbidities. Method: The survey was conducted between July and August 2009 via an online questionnaire, which was sent to 1217 families registered with the French ADHD association. Results: The survey response rate was 23% and key ndings include the following. Symptoms at school were the key driver in healthcare demand in 78% of cases. Waiting time for an appointment with a specialist averaged 8.2 months. More than 80% of parents felt involved in the choice of care for their children, while only 41% of families considered themselves well-informed during the diagnostic process. Of the 70% of children receiving ADHD medication at the time of the survey, 97% showed good adherence to treatment on school days. Conclusion: The survey results suggest that the care pathway for ADHD in France is lengthy, with the average time taken before a specialist consultation estimated to be about one school year. Recognition of ADHD appears to originate at school rather than in a preventive manner by the healthcare system.

P-05-07 Early school enrolment and increased rate of ADHD outpatient service use- risk of undue ADHD diagnosis? O. Albayrak*, S. Beck, J. Hebebrand * Essen, Germany Objective: Recent epidemiological data points to the risk for school children of being diagnosed with ADHD when the child0 s age is relatively young in comparison to the average age of their classmates. This might entail unnecessary clinical consequences such as medication use. We aimed to determine wheather the cut-off date for school enrolment predicts the service use of an outpatient unit for ADHD for those being born right before the cut-off date in the city of Essen, North-Rhine-Westphalia, Germany. Method: We retrospectively analyzed 1800 cases with a ICD-10 Diagnosis of ADHD (ICD-10: F90.0) or hyperkinetic conduct disorder (ICD-10: F90.1) who were referred to our university child and adolescent outpatient unit between 2005 and 2010. Variables were comorbid diagnosis, bith-date, cut-off date for school enrolment for the respective year of service use, date of rst referral, IQ and scores of the Conners teacher and parent rating scales. Results: We found a biphasic accumulation of case referrals in the summer and in the winter months. Further, we found that there were more case presentations of children born in the month before cut-off date for school enrolment than after. Conclusion: Our ndings support the assumption that early school enrolment can lead to an unwarranted diagnosis of ADHD in children who are relative immature due to their young age compared to their older classmates.

P-05-09 ADHD in Tunisia: Clinical and management particularities S. Othman*, Z. S. Abbes, S. Halayem, F. Char, A. Belhadj, A. Bouden, M. Halayem * La Manouba, Tunisia Objective: In this study we aim to analyze the clinical particularities of a sample of Tunisian patients with ADHD and to describe their management Method: This is a cross-sectional study involving 84 children aged 6-16 years old with ADHD. This study was conducted between January 2005 and December 2010. The diagnosis of ADHD was established referring to DSM IV. Every patient had a clinical examination and was assessed by the Kiddie -SADS-PL. The different symptoms and signs, comorbidity and the management of the different disorders were listed. Results: 84 children were enrolled in this study aged 6-16 years. It was found that the disorder was signicantly more common among boys (85%) than females (16%). The combined form is the most common (52%), with frequencies of 10% for the Hyperactive Impulsive and 5% for the inattentive one. We found high levels of comorbidity. ADHD was associated with oppositional disorders in 20.6% of cases, conduct disorders in 8.3% of cases, anxiety disorders in 16.7% of cases, mild mental retardation in 8.3% of cases, enuresis in 8.3% of cases. Difculty maintaining sustained attention, ease of distractibility, difculty sitting still and impulsivity were found with very high rates respectively of 95.8%, 100%, 91.7%, and 91.7%. Methods of treatment involve psychosocial intervention, some combination of behavior modication, life-style changes, counseling, and medication. A stimulant medication was prescribed in 31 of these children only next to other measures of support that is behavioral therapy, speech therapy, sports activities, psychotherapy. Conclusion: The diagnosis of ADHD is based on the observation of a set of behaviors in different environments (family, hobbies, school), and whose treatment is based on complementary and cannot be reduced to a drug approach.

P-05-08 Family healthcare and Attention Decit Hyperactivity Disorder in France C. Getin*, K. Keddad, M. Lecendreux * Groslay, France Objective: Attention Decit Hyperactivity Disorder (ADHD) is a lifetime neuro-developmental disorder, which causes severe impairment in children and adolescents. A recent epidemiological study of children presenting with ADHD in France suggests an estimated prevalence of ADHD of 3.55.6%. A survey was conducted to gather information from the families of children with ADHD about the care pathway in France in order to improve understanding of the needs in this eld.

P-05-10 Preschoolers with ADHD: clinical presentation, demographic data, frequency of methylphendidate treatment and treatment response K. Borregaard*, E. M. Olsen, T. Houmann, J. Dyrborg, C. Anhj * Hillerd, Denmark

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119 Objective: Though ADHD in children and adolescents has been studied thoroughly, the increasing group of preschoolers with the diagnoses has not. Studies have shown that core and associated symptoms can be more severe in preschoolers compared to schoolage children. Comorbidity is frequent and treatment success dependent on the number of comorbid disorders. Effect of stimulant treatment is smaller, side effects are more severe, and often the reason for discontinuation of treatment.(PATS, Kollins et al., 2006.) The purpose of our study is to describe an unselected clinical population of preschoolers with ADHD to improve knowledge about symptom presentation, comorbidity, and treatment response. Method: The study is retrospective and descriptive based on medical records from 2006-2010. 90 children from two university hospitals are included. The inclusion criteria are: age below six years at time of referral, diagnosed with a Hyperkinetic Disorder (ICD-10 diagnoses F90.0-F90.8) or Attention-decit Disorder without hyperactivity F98.8. To describe a true clinical population we included children with comorbid diagnoses of PDD and mental retardation with IQscores above 35. The following are registered: sex, age, IQ, diagnosis, medication type and dose, ADHD-RS score or symptoms described in medical records before and after treatment with methylphenidate. The statistics will include descriptive analyses of distributions and Wilcoxon signed rank sum test concerning treatment outcome. Results: The registration is ongoing but will be completed in due time for the congress. Results concerning clinical presentation, frequency of methylphendidate treatment and treatment response will be presented. Conclusion: It is important to study the growing population of preschoolers with ADHD in order to improve the diagnostic process and to optimize and better predict treatment outcome. This study will add to the sparse knowledge concerning this group of patients and might contribute to an improvement of treatment practice

Friday, 27 May 2011, 14.3016.00 P-06 Epidemiology: Children and adolescents II

P-06-01 The prevalence of ADHD in children at basque country J. M. Garcia Cruz*, X. Txakartegi, A. Bilbao * Vitoria, Spain Objective: ADHD is a behavioural disorder characterised by symptoms of inattention, hyperactivity and impulsivity. ADHD can begin in early infants and most will go on in adult life. Our objective is to know the prevalence in school-age children between 6 and 16 years at basque country, Spain. Method: the performed sampling method was polietapic, stratied and proportional by clusters. 222 individuals were selected in 15 schools (primary and secondary education) at the basque country during one academic year. Results: following the screening stage, based on questionnaires targeting parents and teachers, ADHD was suspected in 18,02% of the students, and a total of 24 cases, representing a prevalence of 10,81%, were conrmed by dsm-iv and clinical interview. Conclusion: signicant differences were found regarding father0 s occupation and his level of instruction. ADHD-combined type is the most found in our research, especially boys. The parents criteria versus teachers criteria, was most appropriate diagnostic tool to patients with ADHD. Multimodal intervention is commonly needed for other conditions and co-morbidities.

P-06-02 A 3 year longitudinal ADHD and ODD prevalence research in a Turkish sample P-05-11 Epidemiological study on symptoms of attention decit and hyperactivity in a sample of 847 Brazilian children of public schools, according to the DSM-IV and teachers ratings S. Antoniuk*, S. Antoniuk, I. Bruck, M. C. Bromberg, E. Maluf, D. Carvalho, M. Richartz, M. Cat * Curitiba, Brazil Objective: To evaluate the prevalence of Attention Decit Hyperactivity Disorder (ADHD) symptoms and its subtypes in relation to school grade, age and gender, according to teachers0 rating and based on the Diagnostic and Statistic Manual for Mental Health-IV (DSMIV). Method: 847 children from 1st to 8th grades of two public schools in Curitiba were evaluated according to teachers0 ratings. Teachers completed a questionnaire with questions taken from the DSM-IV. The subjects were classied as presenting or not presenting attention decits and/or hyperactivity/impulsivity symptoms. Data was analyzed with Pearson0 s chi-square test. Results: Prevalence according to the teachers was 12%. Inattentive subtype was the most frequent (6.9%), followed by hyperactive/ impulsive (3.4%) and combined (1.8%) subtypes. Attention decit incidence was similar for all ages. Hyperactivity/impulsivity were more common for children under 10 years and 2 months (1st to 4th grade). In relation to gender, males (15.9%) were more affected than females (8.3%), with statistically signicant difference. Conclusion: Results conrmed other data in specialized literature. However, the high prevalence may suggest that symptoms were overrated. It is important to point out that the present study used only one source of information and that an accurate diagnosis requires more than one informant besides clinical assessment. B. Kabukcu Basay*, E. S. Ercan, L. A. Rohde, R. Kandulu, E. Uslu, C. Aydin * Izmir, Turkey Objective: This study is designed to nd out the prevalence of Attention Decit Hyperactivity Disorder (ADHD) and oppositional deant disorder (ODD) in a non-referred representative sample from a country in a region where no previous rates are available (Turkey). The second aim is to evaluate the differences in ADHD and ODD prevalences between three different waves with one-year gaps in reassessments. Method: This is a 3 year longitudinal ADHD and ODD prevalence research, conducted among second grades in Izmir, Turkey. The study sample size was calculated to be 1500 (measure of precision: 1%, alpha error: 5%, ADHD and ODD prevalences were assumed to be 5%). 16 schools among total 67 were determined randomly, in regard to low/middle/high socioeconomic classes. For screening, Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S) was delivered to parents and teachers. Screen positive cases and matched controls constructed the study sample (ADHD group: 86 screen positive cases & 85 matched controls; ODD group: 43 screen positive cases & and 43 matched controls). For diagnostic procedures, best estimate procedure is followed and Kiddie-SADS-PL, WISC-R short form and impairment criterion were applied. The sample was reassessed in the second and third waves. Results: First wave ADHD prevalence was calculated to be 13.38%, second wave 12.64% and third wave was 12.04%. ODD prevalence was found to be 3.78% in the rst wave, 0.96% in the second and 5.42% in the third wave. Mean ODD prevalence was found to be 3.38%.

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120 Conclusion: The 3 wave ADHD prevalences were remarkably more than the pooled childhood prevalence of ADHD (6.48%, Polanczyk et al. 2007). ADHD diagnosis was quite stable in reassessments after one and two years. A mean ODD prevalence consistent with the worldwide pooled prevalence (3.3%, Canino et al. 2010) was found; but diagnostic stability was much less compared to ADHD. Results: A total of 4374 students were screened, out of which 273 cases were positive, showing a prevalence of 6.24%. Furthermore, the prevalence was 9% among school boys and 3.7% among school girls, with a male to female ratio of 2.4:1. Learning difculties were as follows: 59.3% for mathematics and 53.1% for language, and the consanguinity was observed in 34.8% of the cases. Conclusion: Prevalence of ADHD in Jordan was found to be within the international values, and the male to female ratios was observed to be high in the whole group as well as in all the subtypes. Furthermore, association with learning difculties was observed to be very strong and the incidence of consanguinity was found to be very high

P-06-03 Incidence and prevalence of adult Attention Decit Hyperactivity Disorder in a large managed care organization in Southern California A. Kawatkar*, T. K. Knight, V. Sikirica, P. Hodgkins, R. A. Moss, M. H. Erder, M. B. Nichol * Pasadena, USA Objective: Incidence (IR) and prevalence rates (PR) for diagnosed treated adult Attention Decit Hyperactivity Disorder (ADHD) are scarce. This study was conducted to estimate IR and PR from a large managed care database, and assess longitudinal trends in a 4-year study period (2006-2009). Method: Kaiser Permanente Southern California (KPSC) electronic medical records from 01/01/2006-12/31/2009 were used to assess IR and PR for adult ADHD (age: 18-100). Calculations were based on: (1) presence of ADHD diagnosis only (DX), or (2) presence of ADHD DX and C 2 FDA-approved ADHD prescriptions (DX?RX), or (3) presence of ADHD DX and C 1 behavioral therapy (DX?BT) visit. IR and PR were calculated based on rst instance of any category to eliminate over-counting. Rates were compared across demographics, cohort, and year. Results: In 2006, IR ranged from 0.02% (DX?BT) to 0.07% (DX). This rate remained stable throughout the 4-year study period. PR in 2006 ranged from 0.15% (DX?RX) to 0.31% (DX). PR increased to 0.24% (DX?RX) and 0.42% (DX) in 2009. However, PR based on DX?BT declined from 0.19% in 2006 to 0.09% in 2009. During the 4-year study period, PR varied only slightly by gender, but sharply by agea roughly 9-fold higher annual increase in the 18-19-year age group versus the 60-69-year age group. Conclusion: In this integrated care population, IR and PR of adult ADHD were low. Consistent annual IR may suggest an accumulation of patients causing increased PR over the 4-year period. The increase in PR over the 4-year period was disproportionately higher in the 18-19 and 20-29 age groups versus the older age groups, suggesting a changing demography of ADHD by age group over time. Similarities in PR across males and females suggest possible equalization of ADHD diagnosis rates in adulthood.

P-06-06 Characteristics of ADHD subtypes in a group of children from canton Ticino G. P. Ramelli* * Bellinzona, Switzerland Objective: Attention Decit Hyperactivity Disorder (ADHD) is a common childhood-onset disorder with a signicant impact on public health. The aim of this study was to study ADHD symptoms and DSM-IV subtypes in children and adolescents in Ticino, along with their features, and therapy and follow-up. Method: A total of 97 children with a diagnosis of ADHD, recognized between 2002 and 2008, were examined and their clinical characteristics, school results and therapy were studied. Results: We considered 97 children (89 male/8 female) aged 3 to 14 years (mean age 8.1) who were followed by our department of child neurology. We divided the children into the three following groups: pre-school (11), primary school (67) and secondary school (18). The subtype most represented in the pre-school group was Hyperactiveimpulsive at 50%. In the primary school group we found the following divisions: Inattentiveness: 37%; Hyperactive-impulsive: 18%; and Combined: 45%. For the adolescents in the secondary school group, the most-represented subtype was inattentiveness at 67%. The therapies were distributed in the three groups in the following way: ergotherapy: 45% pre-school, 28% primary school and 27% secondary school; psychomotor: 54% pre-school, 34% primary school and 16% secondary school; pedagogical support: 18% pre-school, 70% primary school and 83% in secondary school. Drug therapy with methylfenidate was followed by 50% of the children and varied between 9% in pre-school children and 89% in the secondary school. Conclusion: The distribution of the subtype of ADHD is remarkably different between the three groups: the pre-school aged children showed more Hyperactive-impulsive problems, while later problems of inattentiveness are present. Behavioural therapies are available for the children of pre-school age, while the boys of secondary school mainly benet from therapy with methylfenidate. As the most-represented group is that of the primary school age, in the future paediatricians should be able to recognize children with ADHD already at the preschool age in order to begin therapy as soon as possible.

P-06-05 Prevalence of Attention Decit Hyperactive Disorder (ADHD) in school children in Al-Qaser district Jordan O. Na* * Karek, Jordan Objective: To determine the prevalence of Attention Decit Hyperactive Disorder (ADHD), its subtypes, its effects on learning, and some of its associations in Al-Qaser district in South Jordan. Method: School-based screening study Study Population: All school children aged 612 years (both males and females) in Al-Qaser district in South Jordan were screened. Methods: The inclusion criteria comprised hyperactivity, impulsivity, inattention, learning difculties, and failure in school exams. The Arabic version of the fourth edition of Diagnostic and Statistical Manual (DMS-IV) for the diagnosis and classication of ADHD questionnaire was applied to all the students included in the study.

P-06-07 Prevalence of ADHD in Lebanese school-agend population S. Richa* * Beirut, Lebanon Objective: In order to estimate ADHD prevalence in Lebanese school-aged population, we conducted the rst epidemiological study of this kind in our country. Method: A random cluster sampling was used in order to select 1000 children aged between 6 and 10 years, admitted in several schools

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121 across all regions in Lebanon. In each of the ve administrative regions, we selected randomly two districts. In each district, we also chose randomly ve schools and in each school two classes, one from Kinder Garden 2 and one from grade 5. Ten children from each class were included randomly in the population of the study. For each child, an ADHD-Rating Scale IV (Du Paul, 1998) School-version was lled by a main teacher. The Home-version of the same scale was also lled by the childs parents. Results: We found a prevalence of ADHD equal to 32 per 1000 (30 out of 934). The prevalence of ADHD Inattentive subtype was approximately 3 per 1000, the prevalence of the HyperactiveImpulsive subtype was 12 per 1000, and that of ADHD Combined subtype was 17 per 1000. Conclusion: This is the rst epidemiological study to be conducted in Lebanon in order to estimate the prevalence of ADHD among children in school setting. Objective: Since their rst recognition in DSM-IV, the predominance of the three ADHD subtypes remains controversial in ADHD literature. The aim of the present study was to explore the prevalence of ADHD subtypes worldwide, the risk factors and the impairment across subtype classication. Method: We reviewed all the 38 available studies, published in the Pubmed and Google scholar, since 1994, sampling from the general population. Results: These studies indicate that the prevalence of the ADHDInattentive type (ADHD-I) ranges worldwide from 0.2% to 9.9%. For the hyperactive- impulsive (ADHD-HI) and the combined type (ADHD-C), prevalence ranges from 0.1 to 10.9% and from 0.6 to 8.5% respectively. The ADHD-I subtype is the most common form of ADHD, followed by ADHD-C type. In two setting studies, the most prevalent subtype is the combined, whereas in one setting studies, its the ADHD-I. The ADHD-HI type is more prevalent in studies using parent as informants. The male to female ratios for ADHD-C range from 0.6:1 to 7.5:1, averaging 3.3:1, whereas the M:F ratios for ADHD-I range from 0.4:1 to 6:1, averaging 2.0:1. For HI type, the M: F ratios range from 0.5:1 to 10:1, with the average M: F ratio being 2.4:1. The ADHD combined type is associated with greater impairment in both social and academic domains, whereas the ADHD-I shows a higher academic but lower social impairment. The HI type is more prevalent among younger ages and less academically impaired, associated mostly with moderate behavioral problems. Conclusion: Methodology and impairment features, comorbidity, population characteristics and cultural differences involved in studies seem to contribute to the existing variations in the prevalence of the ADHD subtypes worldwide. Future cross- cultural studies of standardized designs must be used in order to draw rm conclusions on the true prevalence of ADHD subtypes and the risk factors.

P-06-08 Early hospital morbidity in children treated for Attention Decit Disorder in Western Australia: A population data linkage study D. Silva*, L. Colvin, F. Stanley, C. Bower * West Perth Wa, Australia Objective: To provide an overview of the Data Linkage systems available in Western Australia (WA) that are linked to all children prescribed stimulant medication (SM) and provide an example of how this data linkage can be used to examine the risk of early hospital admissions in the Attention Decit Disorder (ADHD) child \4 years compared with age, gender and postcode matched controls. Method: Between August 2003 and December 2007, 16,883 children and adolescents (cases) between 4-25 years who have been prescribed stimulant medication in WA for ADHD were recorded on the Monitoring of Drugs Dependency System (MODDS) data base set up in 2003 following a parliamentary inquiry relating to WA having the highest prescription rates of stimulant medication (SM) in Australia. A stratied random sample of birth records with no linkage to MODDS was chosen as a comparison group (32,728). Case and comparison records were linked to the Hospital Morbidity Data Base, Mortality Data Base, Mental Health Data Base, Emergency Data Base, Corrective Services Data Base and Education Data Base, and de-identied data les provided for analysis. Results: Compared with children without MODDS records, children under 4 years who subsequently were diagnosed and treated for ADHD were around 26% more likely to be admitted to hospital with a respiratory condition (OR 1.26; CI (1.19-1.33), 52% more likely to be admitted with an accident or poison (OR 1.52; CI 1.41-1.64), 65% increase risk of admission for ear disease (OR 1.65; CI 1.53-1.78) but no signicant difference for conditions relating to the perinatal period. Gender differences were also signicant. Conclusion: There is signicant early hospital morbidity for both male and female children prior to being treated for ADHD. Data Linkage at a population level can provide information on causal pathways including early injury risk which may be a precursor of subsequent ADHD in childhood.

P-06-10 Prevalence change trend of Attention Decit Hyperactivity Disorder in Taiwan M.-Y. Wang* * Taichung, Taiwan Objective: Attention Decit Hyperactivity Disorder (ADHD) is one of the most prevalent pediatric psychiatry disorders. The prevalence ranges 2-8% among populations by DSM-IV. There are limited population based studies on the trend of this disorder. We used the universal insurance claims data to investigated the chronological trends of ADHD incidence and prevalence among children in Taiwan. Method: We used the National Health Insurance Database of a random sample of 1,000,000 insured population to analyze the annual prevalence rate of ADHD (ICD code 314) from 1996 to 2007. Sociodemographic factors associated with the disorder were also observed. Results: Prevalence rate increased from 0.09% in 1997 to1.1% in 2007 in children 18 years of age and younger, much less than the estimates in other countries. The prevlance was higher in boys than in girls with the boys-to-girls rate ratios of 1.76 in 1997 to 3.78 in 2007. The annual trend showed a dramatic increase in 2003 due to health education promotion in that year. The prevalence was higher in the urban areas than in rural areas and in children less than 10 years of age than the older children. Conclusion: Prevalence rate increased from 0.09% in 1997 to1.1% in 2007 in children 18 years of age and younger, much less than the estimates in other countries. The prevlance was higher in boys than in girls with the boys-to-girls rate ratios of 1.76 in 1997 to 3.78 in 2007. The annual trend showed a dramatic increase in 2003 due to health education promotion in that year. The prevalence was higher in the urban areas than in rural areas and in children less than 10 years of age than the older children.

P-06-09 Prevalence of ADHD subtypes worldwide M. Skounti*, L. Betts * Heraklion, Greece

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Friday, 27 May 2011, 14.3016.00 P-07 Epidemiology: Adults I

P-07-01 ADHD prevalence in a sample of obese women B. P. Nazar*, C. Moreira de Sousa Pinna, R. Suwwan, J. A. Sergeant, P. Mattos * Rio de Janeiro, Brazil Objective: Recent data has suggested that there is a higher prevalence of ADHD among obese populations. Most studies used self-report instruments and data on the subject is scarce. In this study we sought to investigate the prevalence of Attention Decit Hyperactivity Disorder (ADHD) in an obese treatment-seeking sample of adult women, using a semi-structured interview for ADHD. Also, we evaluated the relationship between ADHD prevalence and obesity categories, and if present or past number of ADHD symptoms correlated with current Body Mass Index (BMI). Method: Cross-sectional study Subjects and Methods: One hundred and six adult women, with mean age of 38.9 (?10.7) years and mean body mass index (BMI) of 39.2 (?5.29), were consecutively evaluated. Subjects were interviewed by psychiatrists with the Schedule for Affective Disorders and Schizophrenia module for ADHD, adapted for adults. Patients with psychiatric or neurological conditions that could mimic ADHD symptoms were excluded. Statistical Analysis: Chi-square test was used to determine signicance of differences in the prevalence of ADHD among the WHO classication of obesity categories. The association between ADHD symptoms and BMI was assessed using bivariate correlations (Pearsons or Spearmans when indicated). Results: The ADHD prevalence found in the sample was 28.3% (n= 30; CI: 23,78% to 32,82%), and was higher as obesity categories increased (class I = 5.7%, class II = 9.4%, class III = 13.2%). However, this was but a tendency, without statistical signicance (V2= 0.591 p[0.05). Neither the number of inattention, nor the hyperactivity/impulsivity symptoms, current or past, showed signicant correlation with current BMI (p[0.1). Conclusion: Similar to previous studies, a signicant higher prevalence of ADHD was found in obese individuals, using a semistructured interview. This is way above the expected adult prevalence in population studies of 4.4% (CI: 3.8% to 5.0%). Wewe found a tendency of higher ADHD prevalence in more severe obesity category (class III) but we couldn0 t nd any relationship between the number of ADHD symptoms in different domains and BMI. Since weight regulation is a dynamic proccess it may have suffered the inuence of other factors like eating disorder symptoms (like purging behaviors). Our ndings corroborates the need of investigating ADHD in obese individuals to optimize weight loss treatment.

psychiatric comorbidities. Mental disorders are signicantly more prevalent among the imprisoned population than in communityderived samples. Among these, adult ADHD has been identied as particularly overrepresented in prison inmates. Moreover, ADHD has been linked to criminal behavior and higher probability of encountering problems with the law. Method: A cross-sectional design was used to survey a probabilistic sample of 1, 179 prison inmates in Puerto Rico. Randomly selected sentenced inmates (81.3% males) from 26 correctional institutions completed the Computer Assisted Personal Interview (CAPI) and the Composite International Diagnostic Interview (CIDI). These provide information on socio-demographic characteristics, family history of substance misuse, previous incarcerations, and overall physical and mental health history, including: SUD, Generalized Anxiety, PTSD and Major Depression diagnoses. The Wender-Utah Rating Scale (WURS) was used to assess ADHD symptomatology. 32% of respondents presented signicant ADHD symptomatology. These were contrasted in terms of all aforementioned dependent variables in the Non-ADHD group. Results: High risk behaviors such as unprotected sexual intercourse in jail, Hepatitis B and C infection and having experienced an overdose were all overrepresented in inmates with signicant ADHD symptoms (p \ .01). In terms of psychiatric comorbidity, Major Depression, history of traumatic experiences, as well as Post-traumatic Stress Disorder were more frequently occurring in participants in the ADHD group (p \ .001), albeit not Generalized Anxiety Disorder. Moreover, higher WURS scores were signicantly associated with higher proportion of SUD (p \ .001), specially, Substance Dependence. Conclusion: Overall ndings, as well as the implications for rehabilitation efforts and the provision of clinical services for this understudied and underserved population will be discussed.

P-07-03 ADHD: A new diagnosis in elderly populations J. L. Fernandez Sastre*, A. Rojo Pantoja, E. Fernandez * Vigo, Spain Objective: Attention Decit Hyperactivity Disorder (ADHD) in adults and specically in elderly people is a diagnosis that it can be considered emergent. To date, it hasnt been thought as a possible option to choose from in the differential diagnosis for some given clinical syndromes in elderly people. ADHD could have been underdiagnosed due to the overlap between many symptoms that belong to different syndromes, what is proposed as a hypothesis in this work. Method: A complete research on ADHD and the elderly through the medical literature and a semiological exam of the different symptoms that may overlap like cognitive disorder, psychomotor restlessness, or impulsivity have been made, with the support of a neuropsychological assessment in order to get a better screening. Results: No studies have been done on ADHD in elderly populations. There are just a few short informal articles. Some studies say that approximately 50% of the elderly people who are diagnosed as ADHD have another comorbid diagnosis such as alcohol abuse or anxiety. ADHD is very similar to neuropsychological prole of frontal lobe damage, with attention problems, working memory and planning. The neuropsychological assessment has low specicity and sensitivity and therefore, a high false positive rate. Conclusion: More research on ADHD and the elderly is needed. ADHD is under-diagnosed in elderly populations. Executive functions impairment is frequently attributed to dementia and ADHD isnt considered. Neuropsychological assessment could be a good tool for this. ADHD is proposed as an alternative in pseudodementia diagnose.

P-07-02 Prole of psychiatric comorbidity, health history and socio-demographic characteristics in a sample of Puerto Rican prison inmates with ADHD symptomatology R. Gonzalez*, M. Velez Pastrana, E. Lopez Toro, L. Estrada Rivera, C. Albizu Garcia * San Juan, Puerto Rico Objective: (1) Compare the characteristics of incarcerated adults with and without ADHD symptomatology, including socio-demographic and health and criminal history, psychiatric comorbidities and risk behaviors. (2) Describe a prole of inmates with ADHD symptomatology; including Substance Use Disorders (SUDs) and other

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123 P-07-04 ADHD and mild cerebral dysfunction in adult psychosomatic patients M. H. Warnke*, M. Linden * Teltow, Germany Objective: ADHD is dened as an early acquired syndrome with the core symptoms attention decit, hyperactivity and impulsiveness. There is an overlap or comorbidity to neurodevelopmental, psychiatric and behavioural disorders. The transformation of ADHDSymptoms, into adulthood is of relevant number but not consistent. The resulting disorder appears as a mixture of ADHD-symptoms and neurotic components.In adulthood ADHD patients often suffer from various nervous or neurotic diseases like abuse, depression, anxiety and personality-, eating- or adjustment-disorders. The number of diagnosed cases of ADHD is beyond the expected rate. The discovery of underlying cerebral dysfunctions such as ADHD in these patients could be a relevant step to create a proper treatment strategy. Method: We investigated a test-method that was applied to every patient in a psychosomatic rehabilitation inpatient unit, admitted between 2006 and 2008. These patients suffered from a variety of psychiatric disorders, mostly diagnosed as affective and neurotic disorders. The spectrum of disorders resembled nearly the true incidence in the German working age population. We used a computerized self-rating-scale with 20 items of actual psychopathology. The items should be typical for cerebral dysfunction in minor degree. We compared the results with the computerized ADHD-scale for adults (ADHS-SB-Skala, Rosler, Retz et al. 2004). Results: 1346 patients were assessed. The in-test consistency showed a Cronbachs alpha of 0,81 which indicates a good reliability. The items of our data could be grouped into 3 main factors. These are cognition and orientation, emotion-control and motivation/ drive and vegetative stability. The correlation to the ADHD-scale was signicant. Conclusion: In a psychosomatic inpatient cohort of 1346 patients we nd a broad spectrum of typical psychiatric disorders but rarely the admission diagnosis adultADHD or other hints for cerebral dysfunction. Early acquired organic psycho-syndromes such as ADHD transform in different ways into adulthood and do not necessarily build the core-symptomatology of the actual disorder. With a selfrating-scale we can detect 3 factors that build the classic triangle of organic psycho-syndromes including cerebral dysfunctions. The result shows signicant correlation to a well-established ADHD-scale for adults. Together with the anamnesis the psychopathological items are a mean to detect a cerebral dysfunction as relevant underlying factor for actual psychiatric state. The underlying or hidden cerebral dysfunction such as ADHD could implicate a different therapeutic approach. Findings of those 30 out of 34 inmates conrmed with ADHD, were then compared with ndings of 20 adult males with ADHD assessed at a psychiatric outpatient tertiary unit specialized in ADHD, and with 18 healthy controls. Results: Among the prison group, only 2 out of 30 inmates had received a diagnosis of ADHD during childhood, despite most needed health services and educational support. All 30 subjects reported lifetime substance use disorder with amphetamine as the most preferred drug of choice. Mood- and anxiety disorders were present among half of subjects; autism spectrum disorder among one fourth and psychopathy among one tenth. Personality disorders were also common, and almost all inmates presented conduct disorder prior to antisocial personality disorder. Prison inmates reported more ADHD symptoms during both childhood and adulthood than the psychiatric outpatient group. However, collateral information from parents regarding childhood symptoms did not reveal any differences between groups. Further, the educational level was remarkably lower among inmates compared with the others. Working memory functions were similar between ADHD groups when adjusting for a lower estimated IQ among inmates; both groups performed poorer than controls. Besides, on a continuous performance test, the ADHD prison group displayed poorer results compared with both other groups. Conclusion: This study suggested that prison inmates with ADHD were severely affected by ADHD symptoms and coexisting disorders. Besides, inmates showed poorer executive functions also when controlling for IQ compared with psychiatric outpatients with ADHD and healthy controls. Our ndings imply the need for considering these severities when designing treatment programmes for prison inmates with ADHD.

P-07-06 ADHD prevalence in medical students at Ross University School of Medicine J. Bolaski*, R. Gee, M. M. Cuffy, D. Sharma, J. Douglas * Miami, USA Objective: In order to detect and treat ADHD and also avoid the abuse of stimulants by Ross University Medical Students, strict protocols were developed in 2004 by the Mental Health service of the University. This included psychological testing before treatment was initiated. Adult ADHD prevalence studies in the USA point to prevalence rates of 4.4% for ADHD in adults. There is a paucity of research on prevalence rates for ADHD for medical students in the USA. One study found a prevalence of 5.5% with the use of stimulant medication for non medical reasons being as high as 10.1% A review of the prevalence of ADHD and comparison with prevalence rates of adult ADHD in the USA was done for medical students at Ross University to determine whether there was significant difference from the numbers of adults diagnosed with ADHD in the USA. Method: Testing for ADHD was done using the Connors Adult Attention Decit and Hyperactivity rating scale. Results: For the year 2010 the prevalence rate for ADHD among Ross University students was 0.98%. Males 0.63%, females 0.35%. All cases were of the inattentive type. The prevalence for medical students of the rst semester was 0.08%. Conclusion: The prevalence rate of 0.98% at Ross University is lower than the rates of adult ADHD in the USA and points to the value of policies for medication treatment being adhered to at the University. Given the comparative low prevalence rates and the low prevalence rate in the rst semester, there is the need to educate students to seek testing earlier, when experiencing focusing and concentration problems.

P-07-05 Do prison inmates with ADHD differ from psychiatric outpatients with ADHD and healthy controls in ADHD symptom proles and executive functions? Y. Ginsberg*, T. Hirvikoski, N. Lindefors * Stockholm, Sweden Objective: To explore ADHD, coexisting disorders and executive functions among adult male longer-term prison inmates from a Swedish high-security prison, and to compare ndings with psychiatric outpatients diagnosed with ADHD and healthy controls. Method: Following a screening survey for ADHD performed at Norrtalje Prison, a group of 34 inmates were comprehensively assessed for ADHD and coexisting disorders before enrollment to a randomized clinical trial, evaluating treatment with methylphenidate.

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124 P-07-07 High prevalence of adult Attention Decit Hyperactivity Disorder in Spain: Population-based study M. F. Docet*, J. L. Fernandez Sastre, R. V. Garca-Mayor * Vigo, Spain Objective: To determine the prevalence of Attention Decit Hyperactivity Disorder (ADHD) in an adult population in Spain. Method: This is a prospective population-based study. The screening version of the Adult ADHD Self-Report Scale Version-1.1 (ASRSV1.1), which is validated for Spanish population (82.2%, 95.6%, 94.8% and 84.3% for sensivity, specity, positive predictive value and negative predictive value, respectively), was administered at random to people of 18 years and over, of both genders, from March until December of 2010. The prevalence was calculated as the number of subjects who had four or more checkmarks in the ASRS-V1.1, the prevalence by gender and age was also determined. We considered three age groups: from 18 to 39 years, from 40 to 59 years and 60 years and over. The study protocol was approved by the local ethical committee and all the subjects gave their informed consent. Results: This study includes 323 subjects, with a mean age of 45.914.5 years, 215 (66.6%) women. The global adult ADHD prevalence was 9.3% (95% CI: 6.4-12.2). The prevalence of ADHD in women was 9.8% (95% CI: 6.2-13.4) while in men was 8.3% (95% CI: 3.4-13.2), without statistically signicant differences between them. The prevalence in the different age groups was 8.1% (95% CI: 3.712.5), 11.2% (95% CI: 6.4-16) and 7.6% (95% CI: 1.5-13.7), for 18-39 years, 40-59 years and 60 years and over, respectively (p[0.05). Conclusion: This is the rst population-based study that includes patients of both genders, from a wide age-range interval in which the prevalence of adult ADHD was determined in Spain. The present data is one of the highest prevalence of adult ADHD in the worldwide populations, and is also higher than previous estimations in nonpopulation-based studies in Spain. Signicant differences regarding gender and age were not found. P-07-09 The prevalence of Attention Decit Hyperactivity Disorder in older adults in the Netherlands M. Michielsen*, E. Semeijn, H. Comijs, A. Beekman, D. Deeg, S. Kooij * Amsterdam, The Netherlands Objective: The prevalence of Attention Decit Hyperactivity Disorder (ADHD) has been researched in children and adults but a study of the disorder in older adults in the general population has never been performed. The disorder may have a profound impact on the lives of older patients with ADHD and correct diagnosis and treatment is therefore crucial. In this study we estimate the prevalence of ADHD in older adults in The Netherlands. Method: Data were used from the Longitudinal Aging study Amsterdam (LASA), an ongoing population-based study. ADHD cases were found following a two-phase sampling procedure: 1494 participants at baseline were screened with an ADHD-screening list of Barkley and on 234 subjects (age 63-95 years) a Dutch structured diagnostic interview based on the DSM-IV criteria (DIVA 2.0) was administered in the summer of 2010. Then the weighted prevalence of ADHD was calculated. Results: The preliminary estimated prevalence of ADHD in older adults was 3.9%. The prevalence among men was 5.1% and among women was 2.9%. Conclusion: This is the rst population-based study on ADHD in older persons. With a prevalence of 3.9% the disorder is not rare. The results show that the disorder does not disappear in older age and that it is a lifelong condition. In the future, clinical practices should pay attention to ADHD-symptoms in older adults and consider treatment options for this impairing condition in this age group.

P-07-10 Persistance of ADHD symptoms into seniority related with social functioning F. Philipp-Wiegmann*, I. Rauber, A. Schmitt, M. Bauer, W. Retz, M. Rosler * Homburg, Germany Objective: 296 adults aged over sixty were tested for the occurrence of ADHD over the _lifespan (before and after the 50th year of life) and co-morbidities using _standardized procedures (Barkley Interview, Wender-Rheimherr-Interview, ADHD-DC, Sheehan-Scala, Checklist of co-morbid disorders). Participants were recruited from the authors acquaintances, associations, assisted living facilities and doctors ofces. Method: The two groups (ADHD, non- ADHD) were compared regarding demographic factors and impairment of organizational, emotional regulatory and social interactional abilities in daily life before and after their 50th year of life using the above-mentioned procedures. Results: 11 adults were diagnosed with ADHD by using the ADHD-DC. The 285 probands without ADHD served as the control group. In reference to the age there is no difference between probands with and without ADHD. 63,6% of persons with ADHD are male, 36,4% are female. Furthermore the affected participants are without a solid partnership more often. There are more

P-07-08 ADHD in a forensic facility S. Gangadharan* * Republic Of Singapore, Singapore Objective: the objective is to study the incidence of ADHD in a forensic remand facility in Singapore amongst adults Method: All adult remands from 1st Jan 2008 til 31 st Dec 2008, admitted to the Institute of mental Health remand ward for forensic psychiatric assessments were included in the study. Those patient diagnosed as ADHD were identied. Results: Based on a one year cohort of all cases of remands in the forensic psychiatric wards, the statistics on adhd cases are as follows. Males all cases 530 ADHD cases 3 (all cases were charged with theft) Females all cases 160 ADHD cases 0. Conclusion: The sample of remand excluded serious offences such as murder, rape and drug trafcking. The sample represents Singapore as most cases are remanded in this facility. the percentage of ADHD in the forensic population is small, only 3 out of 530, about 0.6 percent.The assessments is based on clinical psychiatric evaluations, and corroborative history from caregivers.The study did not use any rating scales.

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125 academics included in the ADHD group then in the non- ADHD group (27,3%/7,7%). In addition persons with ADHD changed their profession oftentimes. Conclusion: The impairments by ADHD characterizing symptoms seem to persist into seniority. In comparison to the inconspicuous control group considerable more persons with ADHD are impaired by social dysfunctioning. There is a decrease of reported difculties in family life and partnership over time. The participants refer strong impairments in social connections and leisure activities in seniority. The problems seem to increase. Especially the combined and hyperactive subtype report impairments in social life. sleep length R2=.210). Multinomial logistic regressions showed that seasonal affective symptoms were related to hyperactivity, female gender, unemployment, and later mid-sleep (pseudo R2=.278), and a long sleep-onset latency ([30 min) was related to hyperactivity, study, retirement, short sleep, and unstable sleep rhythm (pseudo R2=.404). Higher BMI was correlated to shorter sleep in both the subject group (q=-.163; p=.042) and in the control group (q=-.165; p=.024). Conclusion: The strong relationships between hyperactive symptoms, delayed sleep, sleep-onset insomnia, seasonal affective symptoms, and BMI were apparent in both the subject and the control groups. Further investigation in a prospective cohort study is needed to understand the hypothesized common origin of the ADHD symptoms and delayed sleep phase, resulting in shorter sleep and associated psychiatric and physical health problems at the long term.

P-07-11 Why blindness adolescence doesnt report ADHD problems? H. Saberi* * Rodehen, Iran Objective: Measure comorbidity of ADHD with other emotional and behavioral problems in blindness adolesence Method: participants were 93 blindness students at high school, selected from two special school in Iran. Results: We found that no one have ADHD problems in at risk level or clinical level. 45/2% report depression problems at clinical level, 32/3% report conduct problem and 6/4% report somatic and Anxiety problems.48/4% report depression problems in at risk level, 16/1% Anxiety problem, 3/2% somatic problem, 3/2% oppositional and 61/3% conduct problems in at risk level. Analysis of question in ADHD subscale show that 51/6% report they have problems with sit quiet sometimes, 35/5% report they are total talkative. Conclusion: It may be possible, blindness change the kind of broblems of people. For example depression and conduct disorder instead ADHD.

Friday, 27 May 2011, 14.3016.00 P-08 Genetics studies

P-08-02 Methylenetetrahydrofolate reductase gene polymorphisms in children with Attention Decit Hyperactivity Disorder C. Gokcen*, N. Kocak, A. Pekgor * Gaziantep, Turkey Objective: The purpose of this study was to evaluate the relationship between 5,10- methylenetetrahydrofolate reductase (MTHFR) polymorphisms and Attention Decit Hyperactivity Disorder (ADHD) in a sample of Turkish children. Method: MTHFR gene polymorphisms were assessed 40 patients with ADHD and 30 healty controls. Two mutations in the MTHFR gene were investigated using polymerase chain reactions and restriction fragment length polymorphisms. Results: Although there were no statistically signicant differences in genotype distributions of the C677T allels between the ADHD and control groups (p=0,678) but the genotypic pattern of the distributions of the A1298C allels was different between the ADHD patients and the controls (p=0,033). When MTHFR gene allels were evaluated with respect to sex, there was no statistically signicant difference between ADHD and male control groups according to MTHFR C677T (p=0,61) and A1298C (p=0,173) allels. In females, no difference was found in respect to C677T between two groups (p=0,949). Although the ratio differed markedly between two groups (ADHD: %88,9 and Control: %42,9), the difference did not reach statistical signicance for A1298C (p=0,106). Conclusion: Preliminary data imply a possible relationship between A1298C MTHFR polymorphisms and the ADHD. Larger trials with larger patient populations are needed to reach denite conclusions whether this mutations is a noteworthy risk factor for ADHD.

P-07-12 Relationships between sleep, seasonal affective symptoms, health, and ADHD: The ASESA study D. Bijlenga*, K. B. van der Heijden, M. Breuk, M. E. H. Lie, E. J. W. van Someren, H. J. T. Swaab-Barneveld, J. J. Sandra Kooij * The Hague, The Netherlands Objective: ADHD has higher prevalence of comorbid sleep disorders, seasonal affective symptoms, unfavorable lifestyle, and health issues as compared to healthy adults. We explored the relationships between ADHD symptoms, sleep characteristics, seasonal affective symptoms, lifestyle, and physical and psychological health. Method: We asked adult patients with ADHD (subjects) and a group from the community (controls) to ll out a questionnaire, involving lifestyle, eating pattern, physical and psychological morbidities and complaints the ASESA questionnaire. We also assessed the ADHD rating scale (ADHD-RS), the Munich Chronotype Questionnaire (MCTQ), the Seasonal Pattern Assessment Questionnaire Global Seasonality Score (SPAQ-GSS), and the Dutch morningness/eveningness questionnaire (VOA). Results: We included 202 subjects and 189 controls. Subjects had signicantly more health problems and reported shorter sleep, longer sleep-onset latency, later mid-sleep, and a less stable sleep/wake pattern than controls. Later mid-sleep and shorter sleep were related to hyperactivity, male gender, younger age, and seasonal affective symptoms using multivariate linear regression (mid-sleep R2=.265;

P-08-03 A neuropeptide S receptor gene variant and adverse life events are associated with increased aggressiveness and inattention in a population representative sample of adolescents J. Harro*, E. Kiive, K.-P. Lesch, J. Maestu, T. Veidebaum, A. Reif * Tartu, Estonia Objective: It has been suggested that neuropeptide S and its receptor (NPSR) are involved in regulation of activity, anxiety and fear. We

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126 explored the possible association of the functional NPSR1 gene A/T variant and adverse life events with ADHD symptoms in a population representative sample of adolescents. Method: The sample was based on the younger cohort of the longitudinal Estonian Children Personality, Behaviour and Health Study originally including 593 nine-years old subjects. During the follow-up in 2004, data of 483 participants, aged 15.60.6 years, were collected. ADHD symptoms were reported by teachers, using the Hyperactivity Scale of af Klinteberg at ages 9 and 15, and SNAP-IV at age 15. The history of adverse life events was self-reported at age 15. Genotyping of the functional NPSR1 rs 324981 locus was carried out as reported in Raszka et al. (Mol. Psychiatry 2010, 11: 1067-1074). Results: At age 9, there was a main effect of NPSR1 genotype on concentration difculties: participants homozygous for the T allele had higher scores as compared to A/A and A/T children (p=0.04). At age 15, an interaction effect of NPSR1 genotype and life events on aggressive and inattentive behaviour was found [F(3, 221)= 5.60 and 5.68, respectively, p= 0.02)]. Girls with the T/T genotype and higher experience of stressful life events had displayed signicantly more aggression and inattention than T/T girls with less frequent adverse life events. Girls with the T/T genotype who had been more often exposed to stressful life events also exhibited higher inattention scores as compared to A-allele carriers. No effect of genotype was found in boys during adolescence. Conclusion: This study provides evidence that the T/T genotype of the NPSR1 is associated with increased reactivity to adverse life events, and this is in part gender specic. Conclusion: Our results suggest that, in addition to clinical samples, the l/l genotype of 5-HTTLPR is associated with inattentive symptoms in general population.

P-08-05 Effect of ADRA2A and BDNF genegene interaction on the continuous performance test phenotype H.-W. Kim*, S.-C. Cho, B.-N. Kim Kim, J.-W. Kim, S. Y. Kim * Seoul, Republic of Korea Objective: Complex phenotypes such as performance on the continuous performance test (CPT) are likely to exhibit epistasis. Genetic polymorphisms of noradrenergic system and brain-derived neurotrophic factor (BDNF), which participates in the differentiation and survival of noradrenergic neurons, have been reported to be associated with the performance on CPT. We evaluated the effect of the adrenergic a-2A receptor (ADRA2A) and BDNF genegene interaction on performance on the CPT in a Korean population with Attention Decit Hyperactivity Disorder. Method: In all, 122 participants with Attention Decit Hyperactivity Disorder (8.6 2.3 years, 104 boys and 18 girls) completed the CPT. The DraI polymorphism of ADRA2A (rs583668) and rs11030101 polymorphism of BDNF was genotyped. Results: Signicant interaction effects were found of ADRA2A rs553668 and BDNF rs11030101 on response time variability (P = 0.011) of the CPT. Conclusion: Our study provides preliminary evidence for the effect of the BDNF and ADRA2A genegene interaction on performance on the CPT in Attention Decit Hyperactivity Disorder.

P-08-04 Effect of the serotonin transporter gene promoter polymorphism on inattentive symptoms in a population representative sample of adolescents E. Kiive*, D. Eensoo, H.-M. Loit, J. Harro * Tartu, Estonia Objective: The role of the serotonin transporter gene linked polymorphic region (5-HTTLPR) in Attention Decit Hyperactivity Disorder (ADHD) has been conrmed by several meta-analyses. However, most of the studies have been limited to clinically referred ADHD patients. The purpose of this longitudinal analysis was to investigate the relationship between the 5-HTTLPR genotype, and adolescent and adult ADHD symptoms in a population representative sample. Method: In the present analysis, data of the older cohort of the longitudinal Estonian Children Personality Behaviour and Health Study, aged 15.60.6 years during the original sampling, were used. Additional data were collected during the follow-ups in 2001 and in 2008 when the subjects were 18.30.5 and 24.70.7 years old, respectively. The original sample consisted of 593 subjects, 260 males, 333 females. Adolescents ADHD symptoms were reported at age 15 and 18 by teachers using the Hyperactivity Scale of af Klinteberg and SNAP-IV, and self-reported at age 25 by using the ASRS. Genotyping was carried out as reported previously (Paaver et al., Psychopharmacology 2007, 194: 545-554). Results: According to teachers reports, 15-years old adolescents with the l/l genotype had signicantly more concentration difculties compared to s-allele carriers (p= 0.01), and this was also observed at age 18 (p= 0.03). No difference in motor restlessness between the l/l genotype and s-allele carriers of 5-HTTLPR was observed at age 15 or 18. Inattention but not hyperactivity/impulsivity symptoms measured at age 18 were also signicantly higher in adolescents with l/l genotype (p= 0.005). At age 25, no association between 5-HTTLPR genotype and self-reported inattentive or hyperactive/impulsive symptoms was found.

P-08-06 Association between BAIAP2 gene polymorphisms and Attention Decit Hyperactivity Disorder in Han Chinese Subjects Z. Li*, Y. Wang, Q. Qian, Y. Chen, N. Ji, L. Liu, H. Li, L. Yang * Beijing, Peoples Republic of China Objective: To investigate the relationship between BAIAP2 and Attention Decit Hyperactivity Disorder (ADHD) or its subtypes and ADHD comorbidities in Han Chinese Subjects. BAIAP2 is asymmetrically expressed in two cerebral hemisphere and participates in neuronal proliferation, survival, and maturation.

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127 Method: The diagnosis was ascertained on the base of DSM-IV. The clinical information and blood samples of 632 ADHD children (525 boys and 107 girls) and 381 controls (297 boys and 84 girls) were collected. 3 SNPs of BAIAP2 were genotyped implementing TaqManTM real-time PCR genotyping technique. The design of casecontrol study was carried out to evaluate the role of BAIAP2 in ADHD phenotypes, subtypes and comorbiditis. Chi-square test, and haplotype analysis were employed for statistical analyses. Results: 1. ADHD:T allele of rs4969385 had signicant association with ADHD children (Chi square=5.582, P=0.018) and male ADHD children (Chi square=3.872, P=0.049). Furthermore, T/T genotype of rs4969385 had signicant association with ADHD (Chi square=5.977, P=0.050). 2. ADHD Subtypes: T allele of rs4969385 had signicant association with ADHD-inattentive children (n=304, Chi square=7.21, P=0.007) and male ADHD-inattentive children (n=234, Chi square=4.494, P=0.034). Furthermore, T/T genotype of rs4969385 had signicant association with ADHD-inattentive children (n=304, Chi square=8.009, P=0.018), and showed higher frequency in male ADHD-inattentive children, but not signicant (n=234, Chi square=4.866, P=0.088). 3. Comorbidties: T allele of rs4969385 had signicant association with ADHD comorbid oppositional dcant disorder(ODD) (n=222, Chi square=3.916 P=0.0478)and ADHD comorbid learning disabilities (LD) (n=202, Chi square=4.907, P=0.0268), and showed higher frequency in male ADHD comordid LD, but not signicant (n=170, Chi square=3.681, P=0.0550). G allele of rs8079626 had signicant association with ADHD comorbid disruptive behavior disorder(DBD) (n=273, Chi square=3.951, P=0.0468), female ADHD comorbid DBD (n=39, Chi square=4.051, P=0.0441) and female ADHD comorbid LD (n=32, Chi square=4.442, P=0.0351), and showed higher frequency in ADHD comorbid LD, but not signicant (n=202, Chi square=3.584, P=0.0583). More details in Table 1. Conclusion: Our results suggest that BAIAP2 may be involved in the etiology of ADHD (especially in ADHD-I) and male ADHD, and may contribute to the predisposition to ADHD with comorbid DBD or LD. We will continue to enlarge the sample number, and there will be some new data added in the next few months. important owing to the increased reliance on self-ratings in the transition from adolescence to adulthood. Method: 5,641 12-year-old twin pairs from the Twins Early Development Study (TEDS) were included in analyses. ADHD symptoms were measured using the Strengths and Difculties Questionnaire (SDQ) Hyperactivity scale, completed by parents, teachers, and selfrated. Structural equation modelling was used to examine genetic and environmental contributions to phenotypic variance and covariance. Results: Heritability was highest for parent ratings (77%), lower for teacher ratings (60%) and lowest for self-ratings (49%). There was a substantial genetic overlap between parent, teacher and self ratings of ADHD symptoms: shared genetic factors contributed 37-66% of the total heritability for each rater. There were also rater-specic genetic factors, accounting for the remainder of heritability. Conclusion: Despite observed differences in heritability, parent, teacher and self-ratings of ADHD measure a common genetic liability. However, different informants also measure unique genetic factors that are not shared with other raters, indicating partial genetic distinction between different informants. These results have implications on how ADHD is measured in clinical practice and research, particularly for molecular genetic studies which require accurate phenotypic denitions for successful genotypic analyses.

P-08-08 Male biasness of Attention Decit Hyperactivity Disorder: Importance of dopaminergic gene variants and environment K. Mukhopadhyay*, M. Das, N. Bhaduri, A. Das Bhowmik, K. Sarkar, P. Ghosh, K. Sarkar, A. Ray, A. Chatterjee, S. Sinha * Kolkata, India Objective: The neurocognitive disorder Attention Decit Hyperactivity Disorder (ADHD) is highly prevalent with a male biasness though the reason still remains unknown. Objective of the present investigation was to explore relations between gene variants and environment in the male biasness of ADHD. Method: Functional polymorphisms in DRD4, DAT1, MAOA, COMT, SNAP25 and DBH genes were explored in eastern Indian ADHD cases recruited based on the DSM-IV. Peripheral blood samples collected from ADHD probands (N=126), their parents (N=233) and age-matched controls (N=96) was used for genomic DNA based analysis of SNPs and VNTRs followed by statistical analyses. Plasma DbH activity was measured by photometric analyses. Results: Signicant association of DAT1 intron8 5R allele (P=0.02), rs362988 G allele (P=0.042), DRD4 exon 3 VNTR-rs1800955 7R-T haplotype (P=0.02), and MAOA-u VNTR-rs6323 3R-T haplotype (P=0.002) with ADHD was observed. MDR analysis revealed signicant epistatic interaction between rs1800955 and rs362988 (IG=2.06%) with signicant main effects of DRD4 exon3 VNTR, DAT1 3UTR and intron 8 VNTR, rs4680 and rs362204, rs1611115 and rs1108580. Signicant correlation between different gene variants, high ADHD score and low DBH activity was also noticed, especially in male probands. Conclusion: Data point toward strong association of these markers with ADHD and partly answers the male biasness.

P-08-07 Shared genetic inuences on parent, teacher and selfratings of ADHD symptoms: A twin study in early adolescence A. Merwood*, C. Greven, T. Price, G. McLoughlin, J. Kuntsi, H. Larsson, P. Asherson * London, United Kingdom Objective: Parent and teacher ratings of ADHD symptoms yield high heritability estimates (70-80%), however a growing body of literature reveals lower heritability for ADHD self-ratings in children, adolescents and adults (*30-40%). To date, few twin studies have examined the heritability of self-ratings of ADHD using large, sameage samples during adolescence, and no study has yet examined the genetic overlap between parent, teacher and self-ratings of ADHD. Understanding the genetic overlap between different informants is

P-08-09 Preliminary results show no distinct pattern of 5,10methylenetetrahydropholate reductase gene polymorphisms in Attention Decit Hyperactivity Disorder A. Tufekci*, Y. Taneli, E. Kirhan, M. Dirican * Bursa, Turkey

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128 Objective: The study aimed to investigate 5,10-methylenetetrahydropholate reductase (MTHFR) gene polymorphism in children and adolescents with Attention Decit Hyperactivity Disorder (ADHD), to test the hypothesis that MTHFR C677T or A1298C polymorphisms may change the susceptibility to ADHD via a change in D4R mediated activity. Method: Thirty-nine children and adolescents (10.3% female) with a diagnosis of ADHD according to DSM-IV were included after IRB approval and written informed consent. Mean age of the study group was 9.5 years (range 6.4-14 years). Severity of ADHD was assessed with the Clinical Global Impression - Severity Scale (CGI-S). MTHFR gene polymorphisms were determined for C677T and A1298C via strip assay (ViennaLab Labordiagnostika GmBh, Vienna, Austria) based on a Polymerase Chain Reaction Reverse Hybridization technique. For continuous variables mean standart deviation results were compared via independent samples t test and Mann Whitney U test; categorical variables were compared with Fishers Exact and Pearson chi-square (SPSS Inc, Chicago, Il, USA), with a statistical treshold of p\0.05. Results: The combined subtype of ADHD was seen in 84.6% of patients, and the predominantly attention decit subtype was seen in 15.4% of patients; the predominantly hyperactive subtype was not found in the study group. MTHFR C677C (normal homozygotic), C677T and T677T frequencies were 46.2%, 48.7% and 5.1%, respectively. MTHFR A1298A (normal homozygotic), A1298C and C1298C frequencies were 38.5%, 41.0% and %20.5%, respectively. Distribution of MTHFR C677T or A1298C polymorphisms did not differ for ADHD subtypes (p[0.05). Distribution of polymorphisms also did not differ for symptom severity of inattention or hyperactivity (p[0.05). Conclusion: In conclusion, our preliminary results do not show a distinct pattern of MTHFR gene polymorphisms in ADHD. Studies with larger samples are needed. the Norwegian sample were associated with disease. Empirical test at gene level also revealed association of Diras2 with ADHD (p= 0,0234). These results indicate that DIRAS2 may play a role in the pathomechanism of ADHD. Conclusion: To get more knowledge about this interesting candidate gene, in situ hybridisations on mouse brain slices and immunocytological double stainings of mouse hippocampal primary cells are done, recently. Moreover the expression of Diras2 in the mouse brain during development is investigated by quantitative real time PCR.

P-08-11 Why do ADHD symptoms and reading disability cooccur? A longitudinal genetic study of more than 12000 twins C. Greven*, F. Rijsdjik, P. Asherson, R. Plomin * London, United Kingdom Objective: Children with Attention Decit Hyperactivity Disorder (ADHD) often experience reading disability due to shared genetic risk factors. The present study examines stability and change of these genetic inuences, and the developmental relationship underlying this association across middle childhood to early adolescence. Method: ADHD symptoms and reading disability were assessed as continuous dimensions in a U.K. general population sample of more than 6000 twin pairs. Parent ratings of DSM-IV based ADHD symptoms and teacher ratings of reading were obtained at two assessments: the rst in middle childhood (child ages 7-8), the second in early adolescence (child ages 11-12). Cross-lagged quantitative genetic analyses were applied. Results: ADHD symptoms and reading disability were highly heritable, and their association was primarily attributable to shared genes. Each trait was signicantly inuenced by stable and age-specic genetic inuences, but their association in early adolescence was not signicantly inuenced by newly emerging genetic inuences. Furthermore, ADHD symptoms in middle childhood contributed signicantly to the presence of reading disability in early adolescence. This contribution of ADHD symptoms to later reading disability was signicantly larger and almost twice the magnitude as the reverse direction of effects. The more prominent impact of ADHD symptoms on later reading disability was largely driven by inattentiveness rather than hyperactivity-impulsivity. Conclusion: Enduring genetic mechanisms appear to be important in the association of ADHD symptoms and reading disability across time. Thus, genetically inuenced aspects of this association may best be targeted by early interventions. Moreover inattentive ADHD symptoms may serve to exacerbate reading disability across time. We are currently extending our analyses to examine the generalizability of our results to other learning disabilities.

P-08-10 Diras2: Candidate gene for Attention Decit Hyperactivity Disorder L. Weiog*, T. Nguyen, C. Jacob, M. Romanos, C. Freitag, H. Schafer, B. Cormand, J. Haavik, B. Franke, K.-P. Lesch, A. Reif * Wurzburg, Germany Objective: Attention Decit Hyperactivity Disorder (ADHD) is a clinically heterogeneous childhood behavioral neurodevelopmental disorder which is highly persistent into adulthood and shows a heritability up to 80%. In previous studies, our group delineated the 9q22 region by both linkage studies and genome-wide association studies as a candidate locus for ADHD. This region harbours the DIRAS2 (MIM: 607863) gene which is coding for a Ras GTPase. The function of the gene product is still unknown but might include the regulation of cell morphogenesis. Method: We thus conducted a case-control association study using the Sequenom iPLEX system in adult ADHD samples from Germany, The Netherlands, Norway and Spain (IMpACT study group) including a total of [1600 cases and [1800 controls. In addition, genotyping of two independent family-based childhood ADHD samples was accomplished. 14 SNPs were selected, which tagged the promoter region, the 5 and 3UTRs as well as the exons of the DIRAS2 gene. Results: In the german aADHD sample six SNPs located in or near DIRAS2 were associated with the disease. Furthermore, within each of the two haplotype blocks observed in the region, there was one associated haplotype One SNP (rs7848810) was associated with childhood ADHD, as well as learning disability. In the IMpACT sample, one marker (rs2297354) in the Dutch and one (rs9695432) in

P-08-12 Association study on NPY and NPY1R and body weight in ADHD T. Renner*, S. Baranski, T. Seip, T. Nguyen, M. Romanos, J. Heinrich, C. Tiesler, M. Gerlach, A. Warnke * Wurzburg, Germany Objective: The Neuropeptide Y (NPY), well established in the development of obesity, is also involved in the pathophysiology of neuropsychiatric disorders. In a previous study an association between a rare functional duplication of NPY and the simultaneous prevalency of obesity and ADHD in a multigenerational family was shown. Here, the role of frequent genetic polymorphisms in NPY and its receptor NPY1R on ADHD symptoms and body weight is

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129 investigated in samples of affected children, healthy controls and an epidemiologic sample of children. Method: The study sample consists of 276 children, diagnosed according to DSM-IV criteria, 144 healthy controls and 522 children of a German epidemiological sample (GINI/LISA). Genotyping of the ADHD sample and the healthy controls comprised 2 SNPs of NPY and 3 SNPs of NPY1R, genotypes of the epidemiological sample were retrieved by GWAS data. Statistical analysis is performed by ANOVA and regression model. Results: Partial analysis shows a trend of an association of the functional NPY SNP rs16147 with body weight in ADHD children. Further analyses are in process. Conclusion: Due to its involvement in neurotransmitter pathways NPY could play a role in the pathophysiology of ADHD, especially in a potential subgroup suffering from comorbid obesity. Further studies on functional aspects of the NPY system are required. P-08-14 Family based genetic study of child ADHD and DRD2/ ANKK1 gene in a french sample M. Wohl*, C. Boni, D. Purper-Ouakil, S. Bahabori * Colombes, France Objective: Association studies found a signicant association between A1 allele of DRD2 gene and ADHD. The substantial heterogeneity underline the need of clinical, temperamental, pharmacogenetic and cognitive samples description accoding to the reward deciency model. Method: A family based association study was conducted on 193 french families with a child ADHD proband. The SNPs were selected to cover the DRD2 gene (rs 6277), the intergenic junction of ANKK1 and DRD2 (rs 2242592), and the ANKK1 gene (Taq1A). DSM IV comorbidities, rs degrees Alcoholism, Cloninger temperamental traits, cognitive prole and methylphenidate response were assessed. Transmission disequilibrium test and genotypes comparisons were done. Results: Nor allelic neither haplotypic transmission bias was observed in the global sample. Alcoholism in relatives, pregnancy smoking and oppositionnal comorbidity did not differ according to genotype. Genotypes differences was observed in methylphenidate response for rs 6277, in conduct disorder comorbidity for rs 2242592, in ADHD subtype, Generalized Anxiety comoirbidity and Trail Making Test performance for Taq1A. An overtransmission of the A1 allele was found in the subsample with generalized anxiety disorder. Conclusion: No global transmission bias of DRD2/ANKK1 gene were observed in our sample. This result is accorded to main previous family based studies but is in contrast with case-controls reports. A signicant transmission bias of A1 allele of Taq1A polymorphism was observed in a sub-sample with Generalized anxiety.

P-08-13 COMT x DRD4 epistasis impacts neural and behavioral response control in adult patients with Attention Decit Hyperactivity Disorder (ADHD) and healthy controls T. Dresler*, C. G. Bahne, M. Heine, A. Boreatti-Hummer, C. P. Jacob, T. J. Renner, A. Reif, K.-P. Lesch, A. J. Fallgatter, A.-C. Ehlis, S. Heinzel * Wurzburg, Germany Objective: Genetic inuences explain up to 80% of phenotypic variability in patients with Attention Decit Hyperactivity Disorder (ADHD). While the prefrontal cortex plays a major role in the expression of ADHD symptoms, it is unclear how putative risk genes and gene-gene interactions (genetic epistasis) might impact neural prefrontal processing and behavioral phenotypes. Here, both dopamine availability and receptor function have been linked to important principles of prefrontal processing, behavioral outcome and genetic risk of ADHD. Method: We genotyped for dopamine D4 receptor (DRD4; 48bp VNTR) and catechol-O-methyltransferase (COMT; Val158Met) gene variation in adult ADHD patients (n=181) and healthy controls (n=114). Gene main effects and DRD4 x COMT epistasis on behavioral and neurophysiological correlates of response control were investigated. To this end, reaction time data and neural response control (NoGo-anteriorization, NGA) were measured by means of a Go-NoGo task and electroencephalography (EEG). Results: While main effects were absent, DRD4 and COMT showed an epistatic interaction on reaction time variability (Go-RT SD) as well as on the NGA. Subjects lacking DRD4 7-repeat alleles (no 7R) displayed a U-relationship between the number of COMT Met-alleles and Go-RT SD, whereas 7R carriers showed an inverted U-relationship. Conversely, NGA values followed an inverted U-relationship in no 7R carriers, whereas 7R carriers showed a U-relationship. Additional gene-dosage analyses further supported the interrelation between prefrontal dopamine levels (COMT) and D4 receptor sensitivity impacting cognitive response control. Conclusion: Our ndings provide rst evidence for an interaction of genotype-dependent dopamine availability with D4 receptor function impacting prefrontal processing and behavioral functioning. Considering these interdependencies, which are discussed regarding differential effects on neural network dynamics, might help to disentangle mechanisms of prefrontal information processing underlying, for instance, signal-to-noise ratios and stable vs. exible neural network dynamics. Furthermore, our ndings may provide important hypotheses of genetic epistasis for future association studies of ADHD.

Friday, 27 May 2011, 14.3016.00 P-09 Etiopathogenesis

P-09-02 Alexithymia and attachment styles in parents of Children with Attention Decit Hyperactivity Disorder C. Paloscia*, C. Rosa, F. Manaresi, R. Guerini, A. Pasini * Rome, Italy Objective: To test the hypothesis that the alexithymic traits and insecure attachment in parents of children with ADHD can modulate

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130 the severity of ADHD core symptoms. We hypothesized that 1) parents of children with ADHD will show higher impairment in their emotion processing and an higher prevalence of insecure attachment compared to control subjects, and (b) insecure attachment and high impairment in emotion processing in parents will be associated with severity of symptoms in children with ADHD. Method: The study included 48 parents of boys with DSM-IV-TR ADHD (7-13 years) and 44 parents of health controls in the same age range. We recruited 48 parents of ADHD children, admitted consecutively to our Institute and to a child outpatients service. Fortyfour parents of children, matched with the patient sample, were recruited in one school of Rome. Clinical evaluation of children was performed with the Kiddie Schedule of Affective Disorders (K-SADS) and Conners Rating Scale. Alexithymia in parents was measured by the 20-item Toronto Alexithymia Scale (TAS-20). Attachment was evaluated with Attachment Style Questionnaire. Analysis of Covariance and regression analysis were used to analyze differences between parents and controls and to evaluate a possible association between attachment styles and symptoms severity Results: Signicant differences were found between controls and ADHD parents in attachment styles. Parents of ADHD children were more alexithymic (p\0.001) and showed an higher prevalence of insecure attachment respect to control group (p\0.001). The severity of symptoms, in ADHD children, was associated to insecure attachment in parents (p\0.001). Conclusion: Alexithymic traits and insecure attachment disrupt parents ability to recognize and regulate their own infant/childs emotional life. These difculties in fathers and mothers of ADHD children could reduce treatment response to classic parent training strategies. By delineating the different possible pathways to modulate ADHD expression, clinicians may be able to develop specic multimodal treatment programmes which address cognitive, emotional and attachment components more adequately. p=0,05, df=68). Preliminary data concerning stress response results dependent on genetic predispositions will be presented. Conclusion: The morning decrease of cortisol level seem to be more rapid in boys with ADHD symptoms just as their stress reaction to cognitive stressor seem to terminate more rapidly than in healthy children. Further research is needed to clarify the role of genetic and environmental factors inuencing the HPA axis function, so that they could be considered in future preventive and therapy concepts.

P-09-05 ADHD symptoms in adults are related to the biological clock H. Caci*, V. Oliveri, K. Dollet * Nice, France Objective: Morningness-eveningness is a genetically-determined trait that measurable in childhood to adulthood and mainly reects the phase of the biological clock. An unique mutation on the CLOCK gene, related to the orientation toward eveningness, was more recently identied as a possible risk factor for ADHD in adults. The aim of this study is to replicate our previous ndings that showed a relationship between inattentive symptoms of ADHD and eveningness in adults. Method: Data were collected as part of the Child and Parents with ADHD and Related Disorders (ChiP-ARD) study. Children aged from 5 to 18 years were randomly selected in a sample of public schools. Upon signed agreement of their parents, the pupils were included. Teachers rated the childs behaviour on several scales using a secured Web site. Besides rating their childs behaviour, parents lled out questionnaires to rate their own behaviour. Their booklet included the Adult ADHD Self-Report Scale (ASRS) and the Composite Scale of Morningness (CSM). Results: 844 booklets were returned but only complete questionnaires (784 ASRS and 809 CSM) were analyzed. The nal sample counts 318 men and 438 women. There is no effect of gender on both total scores, while morningness tends to increase with age (rho=0.106, p\0.004). Factor analyses of the 31 items identied 4 factors: morningness, inattention, hyperactivity and eveningness, respectively. Inattention was more strongly correlated (negatively) with morningness than Hyperactivity. Conclusion: On this random sample of adults from the general population, we replicate our previous ndings on a sample of parents of children referred for ADHD. This is in line with recent neuropsychological and genetical studies. It encourages more integration between chronobiology and neurosciences.

P-09-04 The importance of HPA axis as an etiological factor for ADHD N. Vuksanovic*, M. Bidlingmaier, D. Rujescu, K. Zeber, J. Borns, C. Kern, K. H. Brisch * Munich, Germany Objective: Through the experimental research utilizing animal models, we better understand how early life stress induces alterations in epigenetic programming, subsequent HPA stress response and development of aggressiveness/hyperactive behavior. Additionally, genetic factors seem to play an important role in this process. The objective of our cross-sectional study was to compare HPA axis functionality in children with ADHD and healthy controls. Method: Salivary cortisol levels were measured in a group of boys with ADHD symptoms (N=36, age 4-9 yrs) and in a control group (N=34, age 4-8 yrs) at ve stages: prior to the rst experimental session (K1), before (K2) and after a cognitive stressor (K3), 30 min after the task (K4) and 60 min after (K5). The basal morning cortisol levels were accessed on two different days. Genetic data was collected from all children and their parents. Results: Although there was no difference in morning cortisol levels between the two groups, boys with ADHD-Symptoms showed a faster decrease during the rst two hours and had a highly signicant lower cortisol level at the beginning of the session (T-Wert -4,048, p=0,000, df=69)). The cognitive task was an effective stressor for both groups of children (p\0,01). Boys with ADHD symptoms showed a tendency of faster decrease of cortisol level after the stressor and ended up with signicantly lower cortisol level than healthy controls (T-1,988,

P-09-06 Environmental exposure to bisphenol A and phthalates in relation to childhood attention, behavior, learning, and intelligence, as well as the diagnosis of Attention Decit Hyperactivity Disorder S.-C. Cho*, S.-B. Hong, J.-W. Kim, E.-J. Park, M.-S. Shin, B.-N. Kim, H.-J. Yoo, I.-H. Cho, S.-Y. Bhang, Y.-C. Hong * Seoul, Republic of Korea Objective: Bisphenol A (BPA) is an industrial chemical, widespread in our environment. It is commonly used to synthesize polycarbonate plastics and epoxy resins, and these plastic polymers are extensively applied to the manufacture of various articles of daily use. BPA has been shown to affect brain and behavior in rodents and nonhuman primates, but studies have been lacking on its relationship with human neurodevelopment. Previous studies on phthalate exposure have shown that phthalate concentration was signicantly associated with

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131 verbal IQ and symptoms of Attention Decit Hyperactivity Disorder (ADHD) in school-aged children. We aimed to investigate the relationship between environmental exposure to BPA or phthalates and childhood neurodevelopment. Method: Urinary concentrations of BPA and phthalate metabolites were measured among 1,089 children, aged 8-11 years. Main outcome measures included an intelligence quotient (IQ) test (KEDI-WISC), a continuous performance test (CPT), the Stroop Color-Word Test, the ADHD Rating Scale (ARS), the Child Behavior Checklist (CBCL), and the Learning Disability Evaluation Scale (LDES). Presence of ADHD was also determined with the Diagnostic Interview Schedule for Children Version IV (DISC-IV). Results: Urinary levels of BPA were positively associated with the CBCL scores of anxiety/depression, social problems, attention problems, and total problems, and negatively associated with the Stroop interference score, the LDES scores of listening, thinking, reading, mathematical calculations, and the learning quotient (Table 2). Signicant differences among quartile groups of urinary BPA level were found for the CBCL score of delinquent behavior, the LDES score of listening, and the Stroop color-word score (Table 3). The effects of BPA tended to manifest differently across gender, and inuenced the risk for ADHD (Table 4). Urinary levels of phthalate metabolites were signicantly associated with the KEDI-WISC vocabulary score and the CPT commission errors (Table 5), and the path analysis model revealed that these two variables mediated the association between urinary phthalate levels and the CBCL scores of anxiety/ depression, social problems, attention problems, and aggressive behavior (Figure 2). Conclusion: We have demonstrated adverse impacts of environmental exposure to BPA on childhood cognitive, behavioral, emotional, and learning development. The results suggest its genderdifferential effects, and BPA exposure may increase the risk of developing ADHD. Environmental exposure to phthalates may play a role in social and attention problems of children by contributing to poorer verbal IQ and more impulsive errors. received or returned from her father to the parent house. The hyperactivity episodes were immediately resolved as the little girl has to care for the pet. Conclusion: 1.It is typical in times of extreme family tension that children develop pseudo-behavioral ADHD (pronounced kinetic behavior, unstable emotional variability, cognitive disorganization), with a purely social triggering event (traumatic experience of family breakdown).2. The introduction of a therapeutic pet in a childs everyday life is able to function as a comfort, soothing the childs psychomotor explosions. Prerequisite is an advanced cooperation with both parents.

P-09-08 Ferritin and hyperactivity symptoms in a large clinical sample P. Oner*, O. Oner, E. Cop, K. Munir * Ankara, Turkey Objective: Iron is a co-factor of tyrosine hydroxylase, a critical enzyme in dopamine synthesis. Dopamine is implicated in ADHD pathophysiology. We investigated the association of iron-storage protein ferritin with parent and teacher ratings and cognitive measures after controlling for age, gender, ADHD subtype, comorbid conditions, hemoglobin, mean corpuscular volume and reticulosite distribution width in a large sample of children and adolescents with DSM-IV-TR ADHD. Method: We studied 514 ADHD subjects (439 males; age 7-15, meanstandard deviation: 9.32.2). All index and comorbid diagnoses were established by semi-structured interviews. Conners Parent Rating Scale (CPRS) and Conners Teacher Rating Scale (CTRS) were also obtained. WISC-R Digit Span and Digit Symbol and Trail Making Test parts A (TMT A) and B (TMT B) were assessed as measures of attention and executive function. Multiple regression analyses evaluated the effects of age, gender, ferritin, hematological values, subtype and comorbidity on the CPRS and CTRS Attention, Behavior and Hyperactivity, WISC-R Digit Span and Digit Symbol subtest and the TMT A and TMT B scores. Results: CPRS Hyperactivity score was signicantly associated with ferritin level (B=-.15; t=-3.4; p=.001) with only a statistical trend for CTRS Hyperactivity score. Other CPRS and CTRS scores and cognitive measures were not associated with ferritin level. The hematological values were not associated with any of the measures. Conclusion: This largest cross-sectional eld study to date suggests that lower ferritin level may be a risk factor for parent-reported hyperactivity after controlling for age, gender, ADHD ADHD subtype and comorbidity.

P-09-07 The therapeutic pet as a supporting form of intervention in child pseudo-behavior Attention Defecit Hyperactivity Disorder (ADHD) E. Fourlani*, P. Gouveris, E. Michael, T. Syriopoulou, E. Karachanidi, K. Straka, I. Maggana, A. Hristopoulou * Athens, Greece Objective: The process of a divorce is a traumatic event in a childs everyday life. Preschoolers especially display stressful behaviors as a counterweight to the inherent emotional stress that they suffer. The case of a female infant (4.5 years) with divorced parents is presented with onset of pseudo-behavioral ADHD, supportive-through pettherapy intervention and outcome. Method: The parents (through individual and joint interviews) invoked hyperkinetic behavior on the part of their child: during the return to the parent house, and after staying at the house of her father displayed by highly reactive behavior with elements of panic accompanied by a sudden hyperactivity (refusing to sit quietly in the car, great proneness to minor accidents, long hours engagement with the lift of the parent home), resulting in an extremely difcult delivery time for parents and herself. A thorough social history investigation revealed the childs special love for pets. Therefore it was proposed to bring up one small pet (rabbit), which could be carried both to the mothers and the fathers houses, believing that the pet -as a transitional animate object-, would act as a comfort during stressful time of delivery. Results: The parents followed the instructions: the child was accompanied (it was in her arms) by the rabbit each time that has been

Friday, 27 May 2011, 14.3016.00 P-10 Imaging studies: Children and adolescents
P-10-01 Single-dose Methylphenidate normalized resting-state brain dysfunction in boys with Attention Decit Hyperactivity Disorder: A functional MRI study L. An*, X. Cao, Y. Zang, Q. Cao, L. Sun, J. Ren, Z. Qing, Y. Wang * Beijing, Peoples Republic of China Objective: The neurophysiologic mechanism of methylphenidate hydrochlorides (MPH) therapeutic effect on Attention Decit Hyperactivity Disorder (ADHD) is not fully understood. The regions most frequently involved in MPH effect are frontal cortex, parietal cortex, basal ganglia and cerebellum (vermis). Regional homogeneity

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132 (ReHo) is a newly-developed analytic method for resting-state fMRI study which reects the temporal synchrony of the regional BOLD signal. The specic goals of the present study were (1) to dene the anatomy of ReHo responses related to single-dose MPH in ADHD children with functional MRI; (2) to test the amelioration/normalization effects of single-dose MPH. Method: There were 27 boys with ADHD and 32 age-matched healthy boys. Children with ADHD were scanned twice, in a double-blinded, randomized, counterbalanced way, either after 10 mg MPH or placebo. While control boys were scanned once without MPH or placebo. Data preprocessing was performed in SPM8 (http://www.l.ion.ucl. ac.uk/spm) and data from 5 patients and 2 normal subjects were excluded due to excessive head motion. Subsequent ReHo calculation was done in the software REST (http://restfmri.net/forum). And the nal statistical analysis was performed using SPM8. Voxels with a P value \0.01and cluster size [40 voxels (a corrected threshold of P\0.05 by AlphaSim) were considered to show signicant difference between MPH and placebo condition in ADHD group. Results: 1. Relative to placebo condition, single-dose MPH decreased ReHo in right lingual gyrus and right postcentral gyrus, while increased ReHo in left inferior prefrontal cortex, right superior prefrontal cortex and vermis in ADHD group. 2. Single-dose MPH normalized ReHo differences between ADHD and control group in most clusters (4 in 5) with signicant difference between placebo and MPH condition in ADHD group. Conclusion: Single-dose methylphenidate can normalize most resting-state brain dysfunction in ADHD boys, and the frontal-parietalcerebellum circuit plays an important role in mechanism of MPHs effect on ADHD. Conclusion: We found there was a specic IC showing resting state related abnormality in medication-nave ADHD group. Our results suggest that the abnormality in the non-goal-directed default-mode network prevent attentional lapses might interfere frontal foci involved cognitive control network in ADHD. To conrm the interaction between networks, further studies including task-based intrasubject variability are needed.

P-10-03 ADHD and psychosocial stressors. The DTI ndings about myelinization process among these patients E. Curty*, R. Dominguez, I. Souza, P. Mattos * Rio de Janeiro, Brazil Objective: To identify possible abnormalities in the myelinization process among ADHD children and to investigate how adversities such familial stressors, including domestic violence and parental negligence could be associated with white matter microstructural integrity. Method: ADHD youths and controls were evaluated using structured interviews to investigate ADHD symptoms and other psychiatric disorders. After this process, a diffusion tensor imaging was conducted in eight different areas of interest: cerebral peduncle bilaterally (RCP and LCP), anterior limbs of the internal capsule bilaterally (ALIC), genu (GCC),splenium (SCC) and part of body of corpus callosum (BCC) and cingulum (CI) in order to correlate white matter integrity with ADHD symptoms, psychiatric disoredrs and familial and social stressors. Results: a signicant negative correlation between symptoms of inattention, hyperactivity and IQ was detected and lower IQ was associated with reduced fractional anysotropy (FA) in right cerebral peduncle.Inattention and hyperactivity symptoms by themselves were statistically nonsignicant when correlated to the decrease in FA in the studied areas. Among ADHD children who faced important psychosocial stressors during their lives, FA in the left size of the prefrontal area was decreased when compared with ADHD children without life stressors. Conclusion: Lower IQ and psychosocial stressors are relate to impairments in the white matter integrity.

P-10-02 Default mode network abnormality in medication-naive ADHD boys: Resting-state fMRI study J. Choi*, B. Jeong * Daejeon, Republic of Korea Objective: Pathophysiologic models of ADHD have focused on prefrontal-striatal and mesolimbic circuits on the basis of ndings of executive and motivational dysfunction. A complementary approach is to examine the neural substrates of ADHD-relevant behaviors, such as attentional lapses, through functional connectivity analysis. Momentary lapses in attention have been associated with failure to suppress activity in the default-mode network. For broader understanding of neural correlates in pathophysiology of ADHD, we hypothesized that resting state default mode network activity might be compromised in medication-nave boys with ADHD, and analyzed the resting state brain activity using independent component analysis (ICA), which is data-driven approach, rather than theory-driven analysis. The aim of this study is to test whether resting state default mode network brain activity is compromised in medication-nave boys with Attention Decit Hyperactivity Disorder (ADHD), using independent component analysis (ICA) of Functional MR data. Method: Twenty medication-nave boys with ADHD (mean age 10.32.5) and 28 age-, gender-matched healthy volunteers (mean age 10.32.0) were measured resting state brain activity with a 1.5T Philips scanner and clinical assessment. Functional MR data acquired during resting state of 7 min were analyzed using independent component analysis (ICA). Results: No demographic difference was found between two groups except IQ, which was higher in healthy control group (P\0.001). ADHD group showed signicantly higher scores than control groups in Korean ADHD Rating Scale (P\0.001). An independent component (IC) which includes bilateral precuneus/posterior cingulate cortex, occipito-temporal junction, and anterior cingulate cortex was signicantly less activated in ADHD than in control groups (P\0.05).

P-10-04 Examining volumetric differences in the PFC of a pediatric spanish sample with ADHD and normal controls using a highly-calibrated manual tracing protocol E. Direnfeld*, M. A. Garcia-Barrera, J. Hatter, R. Cauleld, L. Shayegi Nick, J. Wilson, N. Trujillo-Orrego, E. Perez-Hernandez * Victoria, Canada Objective: Studies on the neural correlates of ADHD have identied total PFC volume differences, with either smaller volumes of the right

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133 or left PFC. Some studies have observed a linear relationship between large PFC and impaired attention. Recent studies have examined of subregional volumes of the PFC in greater detail. This study examined the relationship between volumes of four PFC subregions and ADHD in a pediatric sample from Spain. Method: Structural MRI scans of ten children with ADHD and matched controls (N = 20) were collected in Spain. Volumetric manual tracing was conducted using ANALYZE 9.0 (Mayo Clinic, 2009). After preprocessing, PFC-parcellation was completed using a highly-calibrated and reliable protocol previously established within our lab (Garcia-Barrera et al., 2010). Non-parametric Mann-Whitney U analyses were conducted for between-group comparisons and left/ right asymmetry was examined. Inter- and intra-rater reliability was measured using intra-class correlations. IQ was measured using the WISC-IV (Spanish version). Results: Signicantly larger volumes were found in the ADHD group relative to controls in left-PFC (LPFC), U=23.00, z=-2.04, p=.041, r=.46, and right dorsolateral-PFC (RDPFC), U=24.00, z=-1.97, p=.049, r=-.44. Both groups showed similar patterns of left-right asymmetry in all PFC regions (ps[.05). Total brain volume (TBV) did not differ between groups nor did it explain observed differences. Inter-rater (.96-1.0) and intra-rater (.87-1.0) reliability was high. Conclusion: Consistent with only a handful of studies, and in contrast to our ndings with American samples, this study demonstrated larger DLPFC volumes in the right hemisphere of Spanish children with ADHD. TBV did not account for these differences, however our groups differed by IQ which may explain some of these results. Delayed neuronal pruning may also play a role in these volumetric differences. P-10-06 Magnetic Resonance spectroscopy study in cerebellar vermis difference between school age children with Attention Decit Hyperactivity Disorder compared with healthy school age controls N. Gonzalez*, E. Barragan, S. Garza, J. Hernandez, F. Eduardo * Mexico, Mexico Objective: The objective of this study was to evaluate the differences in neurometabolite concentrations in the cerebellar vermis of children with ADHD and healthy controls using proton magnetic resonance spectroscopy (1H MRS). Method: Nine patients were evaluated, ve had a previous diagnosis of ADHD and four were healthy controls. Peaks of N-acetylaspartate (NAA), choline (Cho) and glutamate-glutamine (Glx) were measured and the ratios of the peaks calculated. Results: In children with ADHD, a signicantly increased NAA/Cr ratio (2.62) was found compared to NAA/Cr ratio in healthy controls (1.95). No other differences in measured metabolite concentrations were observed. Conclusion: These results suggest the cerebellar vermis as part of the neurophysiological dysfunction in ADHD, nevertheless further studies are needed to conrm this.

P-10-07 Difference in the cerebellar vermis volume between school age children with Attention Decit Hyperactivity Disorder compared with healthy school age controls; N. Gonzalez*, S. Liendo, J. L. Madrigal, J. Hernandez, E. Barragan, S. Garza, A. Rizzoli

P-10-05 fMRI study with MSIT: Difference in neural activity between school age children with Attention Decit Hyperactivity Disorder compared with healthy school age controls N. Gonzalez*, A. Rizzoli-Cordoba, S. Liendo, E. Barragan * Mexico, Mexico Objective: The objective of this study was to investigate the neural activity in patients with ADHD in the Medial Cortex Cingulate and other frontoparietal regions subserving attention during the MultiSource Interference Task (MSIT). Method: Methods ve children (8-11 years of age) with combinedtype ADHD and ve healthy children underwent block functional magnetic resonance imaging (fMRI) while performing the MSIT. Data was analyzed with SPM2 using general linear model with a synthetic hemodynamic response function. Results: Comparison between the patients and healthy controls during the MSIT. Overall, patients exhibited reduced activation in caudate and putamen, as well as parietal cortex. These are preliminary results. Conclusion: The MSIT produces reliable and robust activation of daMCC and the rest of the cingulo-fronto-parietal attention network in healthy individuals. However we observed hypoactivity in basal ganglia in children with combined-type ADHD. Recent study showed in adults with ADHD Methylphenidate OROS increased daMCC activation during the MSIT and may act, in part, by normalizing daMCC hypofunction in ADHD.. For other hand studies suggested that smaller gray matter volumes in the caudate observed in children with ADHDshow normalization during late adolescence. Our results show probably the children have a different pathways for resolve MSIT and the ADHD children have more decit in basal ganglia than adults. One limitation of our study is the relatively small number of patients tested. However, our sample size is a preliminary result.

* Mexico, Mexico Objective: Structural imaging studies indicate that cerebellum, in particular the posterior inferior vermis, is smaller in Attention Decit Hyperactivity Disorder (ADHD) children compared with control subjects. Our goal was tested these ndings in a sample of Mexican school age children with ADHD compared with a group of healthy school age children Method: Setting: outpatient clinic of pediatric neurology department. Subjects: 7 patients (4 boys and 3 girls) newly diagnosed with ADHD based on DSM-IV criteria, without pharmacological treatment, mean age of 7.42 years (SD: 1.02) and 6 healthy control children, with mean age of 10.34 years (SD: 2.4 years), with an IQ greater than or equal to 80 with Wechsler Intelligence Scale for Children IV (WISC-IV), and without comorbid psychiatric disease veried with a structured interview Kiddie-Schedule for Affective Disorders (K-SADS). Interventions: Children underwent Magnetic Resonance of 10 min total, with a sequence of volumes of 5 min. Images were of adequate quality and found no structural abnormalities of the brain in any patient. MRI were processed using software DICOM and the volume of the cerebellar vermis was measured with MRIcro software. Results: The mean volume of the cerebellar vermis in the control group was 493.21 mm 3 (SD 1.74 mm3). The average volume in ADHD patients was 463.51 mm 3 (SD: 14.98). We found a statistically signicant difference of 29.7 mm 3 between groups. Patients with ADHD had 6.02% less volume than controls. These are preliminar results Conclusion: The ndings of this study, conducted with Mexican pediatric population, are similar to results in previous publications on the subject. The cerebellar vermis is one of the candidate brain regions hypothesized to be involved in the pathophysiology of ADHD. Future studies should explore abnormalities of cerebellar vermis functionality in ADHD populations

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134 P-10-08 The impact of reward on episodic memory formation in Attention Decit Hyperactivity Disorder U. Malecki*, E. Duezel, H. Hinrichs, C. Rehe, S. Tyll, T. Noesselt, H.-H. Flechtner, K. Krauel * Magdeburg, Germany Objective: Motivational and cognitive impairments in Attention Decit Hyperactivity Disorder (ADHD) are commonly ascribed to a dysfunction in dopaminergic frontostriatal pathways. Animal studies have accentuated the importance of dopaminergic reward signals for the consolidation of episodic memories in the hippocampus. This study investigated the effect of reward anticipation on incidental memory formation in children and adolescents with ADHD. Method: Boys with ADHD (N=12, 11-15 years) and normally developing adolescents (n=12, 1117 years) performed an episodic memory paradigm. Event-related fMRI recordings during incidental encoding of visual stimuli in the context of anticipation of reward or non-reward were analyzed with regard to later recognition performance. Results: Even though ADHD patients recognized overall signicantly fewer pictures than healthy adolescents, both groups showed a clear benet in memory performance for stimuli following reward anticipation. In contrast to previous studies, reward anticipation was associated with activations in the ventral striatum and the dopaminergic midbrain in both ADHD patients and healthy controls. In the control group, striatal and midbrain activation was limited to the reward cue. ADHD patients, however, continued to show this activation pattern during the stimulus presentation following the reward cue. Conclusion: Our ndings provide evidence for the dopamine transfer decit hypothesis (Tripp & Wickens, 2008). While healthy control subjects successfully transferred the reward signal to the earliest time point for reward prediction, adolescents with ADHD were reliant on a continued reward signaling in the ventral striatum and dopaminergic midbrain. Tripp G, Wickens JR (2008) J Child Psychol Psychiatry 49:691-704. P-10-10 Differences in neurometabolites measurementes in the cingulus of scholar patients with and without Attention Decit Hyperactivity Disorder by proton MR spectroscopy M. Pizarro*, A. Rizzoli, E. Barragan, E. Flores, A. Partida, S. Garza * Df, Mexico Objective: To describe the differences in neurometabolites measurements in the dorsal anterior cingulal cortex in scholar patients with and without ADHD by proton MR spectroscopy Method: Comparative study of 4 scholar patients with ADHD and 4 controls, univoxel spectroscopy of the left dACC was performed. Results: Mean age of patients was 9 years (2.16) for ADHD group and 9.5(1.29) for controls (non signicative p), mean IQ ADHD 105(3.5) and 9.16(3.81) (non signicative p). Absolute measurement between neurometabolites was statistical signicative only NAA (p=0.021) but not for Glx and Cho (p=1 and p=0.564 respectively). Mean relations between neurometabolites (NAA/Cr and Glx/Cr and Cho/Cr) show not statistical signicatives differences. Conclusion: Results of this study become parte of crescent evidence of estructural, biochemical and functional disorders of the cingulus in escolar ADHD patients. Conclusion: These ndings are consistent with neurofunctional circuits correlates of neuropsychological decits of some working memory and attentional decits commonly found in ADHD.

P-10-11 Functional connectivity patterns differences in drug naive children with ADHD during working memory-related processes H. Slama*, P. Peigneux, A. Mary, M. Kavec, S. Linotte, D. Baleriaux, T. Metens, I. Massat * Brussels, Belgium Objective: The present fMRI (3T) study aimed at investigating and comparing the neurophysiological basis of working memory (WM) in prepubertal children with Attention Decit Hyperactivity Disorder (ADHD) and healthy controls, selected with stringent criteria minimizing potential confounds. Indeed, while decits in WM are key neuropsychological features in ADHD, their underlying cerebral substrates remain poorly understood in children. Moreover, high rates of comorbidity, ongoing medications and behavioural differences in performance may be considered as potential confounds in neuroimaging studies in ADHD, each of these parameters having the potential to impact independently on patterns of cerebral activity involved in WM. Method: Nineteen right-handed, never medicated children fullling DSM-IV criteria for the ADHD combined type and fourteen healthy volunteers participated in this study. WM performance and underlying cerebral activity were measured using a verbal N-back task under two different conditions. In the vigilant/control 0-back condition, subjects had to detect the presence of the digit 2 in a series of digits. In the WM 2-back condition, subjects had to press a button when the displayed digit was identical to the one presented two trials before. Data were analysed using SPM8b. Results: Despite similar WM behavioural performance compared to healthy participants (U=103, p=0.29), children with ADHD exhibit decreased, below baseline WM-related activation levels in a widespread cortico-subcortical network encompassing the bilateral occipital and inferior parietal areas, caudate nucleus and cerebellum. Differential functional connectivity in ADHD as compared to healthy participants was highlighted between these areas and a large network of subcortical and cortical regions involved in WM, as well as between the cerebellum and the functionally connected brainstem red nucleus area.

P-10-09 Voxel-Morphometry and Neuropsychological Analysis in a sample of ADHD children C. B. de Mello*, A. Jackowski, R. G. Nogueira, S. Rizzutti, O. F. A. Bueno, M. Muszkat * Sao Paulo, Brazil Objective: The aim of this study is to examine cerebral gray (GM) and white (WM) matter abnormalities in a group of ADHD children using a voxel-based morphometry protocol and correlate to performance in measures of Continuous Performance Test sensitive to attention functions such as omission, commission and reaction time (Hit Rt) scores, as well to performance in working memory and cancellation tasks, Copy and memory of complex gure of Rey. Method: The sample consisted of 12 children/adolescents with DSMIV TR diagnosis of ADHD (aged 714 years) who were compared with 12 healthy volunteer children/adolescents. A morphological analysis in a 3.0T MRI scan was performed, with incoherent ultra-fast volumetric acquisition T1 weighted images (FSPGRE cubic-pixel) and axial spin-echo T2 weight images, FLAIR, IR and GRE T2, multivoxel morphometry. Results: Comparing to control ADHD subjects showed regionally specic effects (volume reduction) in GM and WM in the left median frontal areas (anterior, motor and right somatosensory cortex), anterior cingulate cortex and parietal lobe and left caudate. Neuropsychological analysis showed difference in Reaction Time (Hit RT), digit span backwards and number of omissions in cancellation tests.

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135 Conclusion: Our results yield novel evidence for a core functional neuroanatomical network subtending WM-related processes in ADHD children, which may participate to the pathophysiology and the expression of clinical symptoms in this disorder. P-10-13 Is the clinical, cognitive and brain biochemical expression of Attention Decit Hyperactivity Disorder different in children born late preterm versus children born at term? L. Ben Amor*, S. Chantal, A. Bairam * Levis, Canada Objective: Attention Decit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in school age children, and prematurity is a recognised risk factor. Late preterm birth, which represents 75% of premature births is associated with ADHD symptoms, more impaired cognitive performance, and increased behaviour problems, than at term birth. However, little is known of the characteristics of ADHD associated with late prematurity. Few studies have directly compared late premature children with ADHD to at term children with ADHD. Objective: To compare the clinical, cognitive and neurobiochemical characteristics associated with ADHD in late preterm children to those of ADHD at-term children. Method: Nine ADHD late preterm children, aged 5 to 13, were matched by age, gender and ADHD subtype with nine ADHD at term children. The Diagnostic Interview Schedule for Children -IV and the Continuous Performance Test were used to evaluate the clinical and cognitive characteristics. Proton magnetic resonance spectroscopy was used to measure the ratio to creatine of glutamate, choline and glutamate-glutamine in both prefrontal and striatal regions, and the left cerebellum. Results: The groups did not differ on clinical outcomes. However, compared to ADHD at term group, ADHD late term group has reduced reaction time on the Connors continuous performance test (p B 0.005), as well as lower ratios of choline in the right striatum (p B 0.05) and of Glutamate in the left cerebellum (p B 0.03). Conclusion: Among children with ADHD, those born late preterm have increased performance on an attention test, associated with lower relative concentrations of brain metabolites in the striato-cerebellar regions than those born at term. Conclusion: Etiological factors of ADHD could play a role in the expression and course of ADHD.

P-10-12 Adolescent brain have different activation pattern against different reward condition. J. Son*, W.-H. Choi, Y.-F. Kim, S. Y. Park * Cheongju, Republic of Korea Objective: Adolescence have a tendency to seek any kind of reward. The purpose of this study was to investigate the brain activity when adolescence perform some task with various reward system. Method: 15 adolescence were recruted. After they performed the right-left discrimination test, 4 kinds of feedback were showed - no reward, performance reward, evaluative reward, monetary reward. And the brain activity was measured using FMRI. Results: In performance reward situation vs. no reward situation, lt.superior frontal gyrus(BA 9) and caudate nucleus were signicantly activated. In evaluative reward situation vs. no reward situation, caudate nucleus and rt. culmen of cerebellum were signicantly activated. Finally, in monetary reward situation vs. no reward situation, rt. middle frontal gyrus(BA 10) and other brain regions were signicantly activated. Conclusion: These results suggest the activation pattern of adolescent brain in different reward situation would be different from each other.

P-10-14 Basal ganglia differences between good or bad responders to metilphenidate in ADHD children. A VBM and a ROI-based study A. Moreno*, L. Duno, E. Hoekzema, M. Picado, L. M. Martin, O. Vilarroya * Barcelona, Spain Objective: The rst choice pharmacological treatment for Attention Decit Hyperactivity Disorder (ADHD) is methylphenidate (MPH). However, around 30% of the patients do not show signicant improvement in response to MPH (Grizenko et al., 2006; TerStepanian et al., 2010). An identication of eventual bad responders at the moment of the diagnosis could benet such patients, improving their management and avoiding possible complications. Yet, no clinical or neurobiological markers have been found so far that can distinguish good and bad responders. Our study aims to evaluate whether there are structural brain differences between good or bad responders to MPH. Our hypothesis is that differences would be found in territories rich in dopamine receptors, such as the striatum. Method: We performed a Voxel-Based Morphometry (VBM) analysis on anatomical brain MRI scans obtained from 27 ADHD medication-nave subjects at the moment of the diagnosis. Following

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136 the acquisition, the subjects began MPH treatment. Decision about good or bad response to MPH was established approximately one month after treatment initiation based on clinical criteria. Images were acquired in a 3T MRI Scanner and the analysis was performed using SPM5 software implemented in Matlab 7.0. Region of interest (ROI) analyses were performed in the nucleus accumbens, the caudate and the cerebellum. Results: Sixteen patients showed signicant improvement with the treatment, while eleven were qualied as bad responders. The VBM and ROI analyses indicated greater gray matter volume in good responders in bilateral nucleus accumbens and bilateral caudate head. Conclusion: Our ndings not only support the hypothesis that these structures play an important role in the pathophysiology of ADHD, but also implicate the neurochemical characteristics of these structures in the response to pharmacological treatment. These ndings might be useful to determine a neuroanatomical phenotype that differentiates good and bad responders at the moment of the diagnosis. sample of unprecedented size compared with a matched control group of healthy study participants. Method: Diffusion weighted images images have been acquired for 92 patients and 84 healthy controls, matched in gender, age and IQ. The obtained fractional anisotropy (FA) and mean diffusivity (MD) maps of each subject were normalized to an originally created study template derived from the 84 structural T1-weighted images of the healthy control samples using Dartel diffeomorphic algorithm (Ashburner 2007). Results: Comparing FA values of the patients and controls in a voxelwise analysis showed signicant differences between groups in the right cerebellar hemisphere0 s white matter. Other areas failed to reach signicance. MD values did not vary signicantly across groups. Conclusion: The current study is the rst to report cerebellar FA abnormalities in adult ADHD patients. Correspondingly, cerebellar volume differences have been described in a study comparing a large sample of ADHD children to healthy controls (Castellanos 2002). It has been hypothesized that cerebellar functions comprise the reproduction of an internal model which contains essential properties of cerebral mental representations (Ito 2008; Schmahmann et al. 2007). Cerebellar dysfunction may affect those internal models contributing to symptoms like affect dysregulation, as well as poor attentional and behavioral control.

P-11-02 Cerebellar volume decits in adult ADHD S. Maier*, E. Dieter, E. Perlov, S. Kloppel, A. Philipsen, L. Tebartz van Elst * Freiburg, Germany Objective: Volumetric decits have been reported in many studies of ADHD in children (Valera:2007) and in a smaller number of mostly recent studies on adult ADHD (Ahrendts et al. 2010, Seidman et al. 2010). In adult ADHD volume differences have been reported for several different areas, among those the anterior cingulate, dorsolateral prefrontal, orbitofrontal and occipital cortex, the basal ganglia and the cerebellum (Ahrendts et al. 2010, Amico et al. 2010, Hesslinger et al. 2002, Seidman et al. 2006). A recent study investigating a large sample of ADHD patients and controls found a reduced caudate volume in ADHD patients (Seidman et al. 2010). In the present study we investigated structural decits in ADHD using voxel based morphometry in a sample of unprecedented group size. Method: T1-weighted structural images of 99 ADHD patients and 92 healthy controls, matched in age, IQ and sex have been acquired on a 3 tesla scanner. Structural image were analyzed in SPM8 using VBM8 image segmentation (Christian Gaser, University of Jena) and registered onto a template applying dartel diffeomorphic image registration (Ashburner 2007). Results: Compared to healthy control subjects, ADHD patients showed signicantly smaller volumes in the right cerebellar and insular white matter after controlling for family wise errors. Other brain areas and grey matter structures failed to reach signicance. Conclusion: Our results of cerebellar volume abnormalities in ADHD patients are in line with earlier studies in children reporting smaller cerebellar volumes (Castellanos et al. 2002, Valera et al. 2007). Apart from its function in motor control the cerebellum is thought to serve as modeling unit for affective and cognitive processes (Ito 2008). Patients suffering from lesions affecting the posterior cerebellar lobe manifest affective, behavioral and cognitive impairments (Schmahmann et al. 2007) which show overlap with symptoms of inattention, poor behavioral and poor affect control described in ADHD.

Friday, 27 May 2011, 14.3016.00 P-11 Imaging studies: Adults

P-11-01 Altered integrity of cerebellar white matter in adult patients diagnosed with ADHD P. Goll*, S. Maier, E. Perlov, S. Kloppel, D. Endres, A. Philipsen, L. Tebartz van Elst * Freiburg, Germany Objective: Structural and functional abnormalities in ADHD neuroimaging studies have been reported for various distinct brain areas. White matter (WM) volume abnormalities and disrupted white matter integrity were detected in children and adults affected by ADHD in several brain regions (Castellanos et al. 2002; Ashtari, M. et al. 2005; Seidman et al. 2006). As for adults, frontal and temporal white matter disruptions have recently been described (Konrad et al. 2010). The focus in this study was to examine structural connectivity in a patient

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137 P-11-03 A proton MRS study of the Basal Ganglia, Dorsolateral Prefrontal Cortex and Parietal lobe in Adults with Attention Decit Hyperactivity Disorder S. Maltezos*, S. Coghlan, T. Lavender, R. OGorman, C. Skirrow, K. Xenitidis, P. Mark, D. Spain, P. Asherson, D. Murphy * London, United Kingdom Objective: 1H-MRS studies have demonstrated alterations in several brain metabolites concentrations including glutamate/glutamine (Glx), N-acetylaspartate (NAA), choline (Cho) in individuals with ADHD. The purpose of this study was to investigate neurochemical differences (using 1H-MRS) in frontal, striatal, and parietal regions and the effect of psychostimulant medication, comparing psycho stimulant nave and medicated adults with ADHD and a healthy group. Method: 39 adults with ADHD (combined type: 22, inattentive type: 17) were compared to 21 age, gender and IQ matched controls. 22 of the individuals with ADHD were psychostimulant naive. Connors Adult ADHD Diagnostic Interview (CAADID) was used as screening/ diagnostic measure. MRS studies were performed with a 1.5T GE HDx MRI scanner equipped with TwinSpeed gradients. Single voxel 1H MR spectra were acquired with a PRESS sequence with repetition time (TR) = 3000 ms and echo time (TE) = 30 ms. Voxels of interest (VOI) were positioned in the left medial parietal lobe (20 9 20 9 20 mm3) left dorso-lateral prefrontal cortex (DLPFC) (16 9 24 9 20 mm3), and left basal ganglia (BG) (20 9 20 9 15 mm3). MRS concentrations were corrected for VOI CSF and grey/white matter content. Results: Subjects with ADHD had a signicant reduction: 1) in BG concentration of Cr?PCr, NAA, Glx, and Cho, 2) in DLPFC NAA, Cr?PCr and Cho, and 3) in Parietal NAA and Glx. We found signicant correlations between Parietal Glx and symptom severity as indexed by CAADID scores. No differences were found between psychostimulant medicated and unmedicated ADHD subjects. Conclusion: These observed decreases in concentration of various neurometabolites point to a systemic decit in mitochondrial/neuronal dysfunction or myelination, cellular energy metabolism, and neurotransmission across a widespread network of frontal, striatal, and parietal regions suggesting that neurochemical abnormalities in ADHD patients are likely to continue beyond childhood into adulthood. These observed differences are unlikely to represent treatment effects, but rather reect the underlying pathophysiology of ADHD. Results: We tested (a) whether we can replicate recent ndings of amygdala subdivision connectivity in healthy subjects and (b) whether patients with ADHD and healthy controls differ regarding amygdala subdivision connectivity strength and (c) whether ADHD symptom severity is correlated with resting state connectivity. Conclusion: Exploring amygdala-based networks may help to better understand distinct aspects of the clinical phenotype. Implications for motivational theories of ADHD are discussed.

P-11-05 Functional brain imaging of delay aversion in adult ADHD G. Wilbertz*, A. Trug, J. Blechert, L. Tebartz van Elst, E. Sonuga-Barke * Freiburg, Germany Objective: To explore behavioral as well as physiological signs for delay aversion in adult ADHD. Method: Preliminary data consist of twelve adult patients with ADHD (all subtypes, 4 men, mean age 39 years) and twelve matched control subjects tested on four tasks regarding delay aversion: a hypothetical delay discounting task (DD, Rachlin et al., 1991), the continuous delay aversion task (ConDAT, Muller et al., 2006), the delay frustration task (DeFT, Bitsakou et al., 2009) and a modied version of the monetary incentive delay task (Knutson et al., 2001) with three levels of forced delay as punishment during the trials (the motivational delay avoidance test, MoDAT). Functional magnetic resonance imaging (fMRI) was measured during both of the last two tasks. Results: Behavioral data show signicant associations of ADHD symptom severity with DD and ConDAT but no reliable group differences. Brain activity in the amygdala, ventral striatum and anterior insular cortex is signicantly more affected by delay anticipation in the ADHD than in the control group. In contrast, healthy subjects exhibit a stronger modulation of the anterior cingulate cortex. For the processing of delay punishment no clear pattern appears. Groups do not differ regarding DeFT. Conclusion: Abnormal delay aversion can be demonstrated behaviorally as well as physiologically in adult ADHD and seems to account for the impulsive symptomatology. However, heterogeneity and small effect sizes point to yet undened subtypes of ADHD. Establishing methods to reliably assess delay aversion is important for the validation of current psychopathological models.

P-11-04 Amygdala subdivision connectivity in adult patients with ADHD M. M. Plichta*, S. Esther, D. Mier, C. Sauer, O. Grimm, A. B. M. Gerdes, D. Sabljic, B. Alm, P. Kirsch * Mannheim, Germany Objective: Cumulating evidence suggests the importance of decits in emotional brain circuits for the pathophysiology of ADHD. Functional as well as structural alterations of the amygdala have been recently reported in patients with ADHD. Animal research, however, has shown that the amygdala is composed of several nuclei which may differentially contribute to the processing of emotion through interactions with other subcortical and cortical structures. Thus, exploring amygdala-based networks may help to better understand distinct aspects of the clinical phenotype. Method: We examined functional connectivity of three cytoarchitectonically dened subdivisions of the amygdala (laterobasal, centromedial, supercial) during rest using seed voxel method in adult patients with ADHD and healthy controls.

P-11-06 No difference of dopamine transporter availability in adults with Attention Decit Hyperactivity Disorder C.-B. Yeh*, M.-C. Lo, C.-J. Chang, K.-H. Ma, W.-S. Huang * Taipei, Taiwan Objective: Attention Decit Hyperactivity Disorder (ADHD) affected 5-10% of children and 4% of adults. Previous studies showed that the dopamine system is involved in ADHD. The aim of this study was to investigate the relationship between ADHD and the availability of dopamine transporter (DAT). Method: The subjects were divided into ADHD group and healthy controls. They were interviewed to assess the severity of ADHD symptoms and received SPECT using TRODAT to explore the availability of DAT in the brain. They also received neuropsychological tests including Continuous Performance Test (CPT), Iowa gambling test. Results: Thirty-two ADHD patients and twelve normal healthy controls were recruited. No signicant difference of availability of

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138 DAT between ADHD and control groups found. The availability of DAT was associated with the result of CPT. Conclusion: The ADHD adults not comorbid with oppositional deant disorder, conduct disorder or substance use disorder might be without the abnormality in dopamine system. However, the DAT availability was associated with the impaired executive functions in ADHD. Our result was not line with previous studies might be due to the younger age of control group, or the neurotransmitters other than dopamine are involved in ADHD. the infraorbital prefrontal cortex and the bilateral antero-medial temporal lobes, i.e, the pattern often seen in SPECT scans of patients with ADHD. The patient was treated with lisdexamfetamine 50mg per day, with excellent resolution of her BPD symptoms. The 3D SPECT scans of this patient are presented. Conclusion: Some patients with a clinical diagnosis of BPD may show 3D SPECT neuroimaging results of a dysfunctional prefrontal cortex, similar to what is seen in ADHD patients. Such patients may respond to the same stimulants used to treat ADHD. More work is indicated in this area. P-11-08 Correlation of inattention and impulsivity with regional brain volume in adult patients with ADHD A. Konrad*, T. Dielentheis, G. Vucurevic, M. Huss H. Schneider*, M. McLean, M. Freeman, J. Thornton, M. van Lierop, R. Tarzwell * Toronto, Canada Objective: Work by Philipsen has shown that adults with BPD (Borderline Personality Disorder) have an increased prevalence of childhood ADHD (Attention Decit Hyperactivity Disorder). Brain SPECT (single photon emission computed tomography) scans indirectly show functional (metabolic) activity via measurement of regional cerebral blood ow. How do brain 3D SPECT patterns compare for patients with a clinical diagnosis of BPD versus ADHD? Method: Three hundred community patients (approximately 5% with BPD, 20% with ADHD, 75% other diagnoses) across the lifespan received 3D SPECT scans. * Mainz, Germany Objective: Inattention and impulsivity are key symptoms of Attention Decit Hyperactivity Disorder (ADHD). Structural and functional neuroimaging studies of subjects with ADHD demonstrated abnormalities primarily in the frontal-striatal circuitry. However, there is only little evidence about the correlation of these abnormalities with ADHD symptomatology. Therefore, the aim of this magnetic resonance imaging (MRI) study was to examine the correlation of regional brain structure with attentional performance and impulsivity in adult ADHD patients.

P-11-07 3D brain SPECT imaging of ADHD presenting as Borderline personality disorder: A case report

Results: The majority of patients with a clinical diagnosis of BPD were found to have on SPECT scan functional defects in the infraorbital prefrontal cortex, the same pattern seen in our patients with ADHD. Functional defects were also seen in the antero-medial temporal lobes in both the ADHD group and the BPD group, but more often in the latter. We present the case of a 15 year old female who presented with a several year history of 8/9 of the DSM-IV criteria of BPD without meeting fully the DSM-IV criteria for ADHD. A 3D SPECT scan of the patients brain showed large functional defects in

Method: We investigated 29 adult ADHD patients (16 males), all subjects underwent a detailed clinical interview as well as a neuropsychological test battery. Attentional performance and impulsivity were assessed with the Test of Variables of Attention (TOVA). Structural MRI datasets were acquired on a 1.5 T scanner. Voxelbased-morphometry (VBM) was conducted using the optimized protocol implemented in SPM8 (statistical parametric mapping). Voxelbased correlation analyses with measures of attentional performance and impulsivity were performed, the results were thresholded at an uncorrected P \ 0.001. Results: The VBM correlation analyses showed signicant (positive) correlations between attentional performance in the caudate nucleus. Impulsivity scores correlated negatively with regional caudate

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139 volume, though this correlation failed to be signicant at an uncorrected P \ 0.001. Conclusion: This is the rst VBM study showing a correlation between attentional performance and volume of the caudate nucleus. We provide further evidence that basal ganglia abnormalities contribute essentially to ADHD symptomatology. P-11-09 Increased Creatin, Cholin and Glutamate 1 Glutamin (Glx) concentrations in hyperactive patients with ADHD D. Endres*, E. Perlov, S. Maier, P. Goll, A. Philipsen, L. Tebartz van Elst * Freiburg, Germany Objective: Cerebral neurometabolic alterations, especially of dopamine, might play an important role in the pathogenesis of ADHD. According to Carlsson and coworkers there is a highly regulated interplay between dopaminergic and glutamatergic neurotransmission (Carlsson, 1999; Carlsson, 2001). In a previous study of the cerebellum using chemical shift imaging, we showed increased Glx/Cre ratios in the left cerebellar hemisphere (Perlov, 2010). To test for cerebellar involvement in pathogenesis of ADHD, we examined a region of interest in the left cerebellar hemisphere using single voxel spectroscopy. Method: We measured 118 patients with ADHD and 83 controls. For analysis, we used single voxel spectroscopy for absolute quantication of neurometabolites using the LC model algorithm (Provencher, 1993). Measured metabolites were Creatin (Cre), Cholin (Cho), Glutamat?Glutamin (Glx), N-Acetylaspartate (NAA) and Myoinositol (Ins). CAARS Rating Scale was used to distinguish the DSM-IV ADHD subscales of inattentive, hyperactive-impulsive and total ADHD symptoms. Results: We found no signicant differences in the measured metabolite concentrations in left cerebellar hemisphere between controls and ADHD patients. However, in a subgroup analysis we found signicantly higher absolute concentrations of Cre (p=0,012), Cho (p=0,023) and Glx (p=0,023) in patients with ADHD fullling the DSM criteria for hyperactivity and impulsivity (n=33) compared to a control group (n=33) matched in sex, age and IQ. Conclusion: According to our previous ndings, we found signicant higher concentrations of cerebellar Glx in patients, but only in the subgroup with symptoms of hyperactivity and impulsivity. Recent theories discuss a cerebellar involvement in behavioral regulation and affective control (Ito, 2008; Schmahmann et al. 2007), two domains which are known to be impaired in ADHD. Whether cerebellar abnormalities found in the present study contribute to ADHD symptoms of poor impulse and affect control should be addressed in future studies. treatment. The control group was composed of 32 scholars from public schools and followed the same inclusion criteria regarding age and sex. The evaluation was made through the Motor Development Scale, described by Rosa Neto, which were used in all tests available: ne motricity, gross motricity, balance, body scheme, spatial and temporal organization. All tests were applied in one session, wtith medium time of 40 min. For the statistical analysis used Stata software version 11.0 (Stata Corporation, College Station, TX, USA) and used the Shapiro-Wilks tests, Student t test, Mann-U test Whitnney. Results: The results showed that the functions in all areas studied were lower in case group than the control group, although in most cases represent normal values according to scale (53% had normal development medium, 29% normal low, 9% much inferior 6% normal high and 3% inferior). Most children with ADHD (88.3%) achieved negative ages (average -12.8 months) in the difference general motor age and chronological age. In the control group, the average of negative age was equal to 3.9 months and occurred in 53.1% of the sample. Statistically signicant differences between groups in general motor age (p = 0.004), general motor quotient (p \0.001), balance (p = 0.008), spatial organization (p \0.001), ne motricity (p = 0.009) and gross motricity (p = 0.008). Conclusion: The ADHD combined type patients usually have problems in psychomotor performance. Knowledge about the psychomotor prole of these children may assist in determining treatment proposals in order to minimize losses in their quality of life.

P-12-02 The relation between cognitive empathy, beliefs about aggression and proactive aggression in children and adolescents with disruptive behaviour disorders L. Su*, Y. P. Ooi, R. P. Ang, S.-J. Weng, J. C. Liu, A. Raine, D. S. Fung * Singapore, Singapore Objective: Existing literature has reported signicant relationships between empathy, beliefs and aggression. Empathy has also been discussed as a multi-dimensional construct, where individual components may have different effects on aggression. In this study, the relationships between cognitive empathy, beliefs about aggression, and proactive aggression were examined. Method: Participants were 101 patients aged 916 from a child psychiatric clinic in Singapore, diagnosed with disruptive behaviour disorders (DBD), i.e. ADHD, CD and ODD, through the Computerised Diagnostic Interview Schedule for Children (C-DISC). As part of a larger, ongoing study, participants completed the Normative Beliefs about Aggression Questionnaire (NOBAG) (Huesmann & Guerra, 1997), Cognitive-Affective-Somatic Empathy Scale (CASES) (Raine, 2009) and Reactive-Proactive Aggression Questionnaire (Raine et. al., 2006). Linear regression and correlational analyses were conducted to examine the relationships between beliefs about aggression, cognitive empathy and proactive aggression. Results: Stronger beliefs about aggression was found to signicantly predict higher proactive aggression, b = .26, t (86) = 2.58, p \ .05. Higher cognitive empathy also signicantly predicted higher proactive aggression, b = .25, t (86) = 2.44, p \ .05. Beliefs was not signicantly correlated to cognitive empathy, r (103) = .06, p [ .05. Conclusion: The nding on beliefs predicting proactive aggression is consistent with existing literature, further supporting the use of cognitive-behavioural therapy (CBT) programmes that target change of aggressive beliefs. Contrary to previous ndings, higher cognitive empathy was associated with higher proactive aggression. Higher cognitive empathy may indicate a higher capacity to understand and manipulate the thoughts and feelings of others, which is typical in individuals carrying out proactive-aggressive acts such as bullying. By targeting different dimensions of empathy, effectiveness of

Friday, 27 May 2011, 14.3016.00 P-12 Pathophysiology: Children and adolescents I

P-12-01 Psychomotor prole of children with Attention Decit Hyperactivity Disorder combined type J. Goulardins*, E. Barbante Casella, J. Marques, M. Periotto, S. Pacheco, T. Freire, U. Reed * Sao Paulo, Brazil Objective: The aim of this study was to determine the psychomotor prole of children with ADHD combined type. Method: The case group consisted of 34 boys, aged between seven and 11 years, with the diagnosis for ADHD combined type, without comorbidity (except oppositional deant disorder) and virgin of

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140 interventions may hence be improved. Also, non-signicant correlations between cognitive empathy and beliefs about aggression have clinical implications on CBT programmes that assume co-existence of beliefs and empathy issues. and the BRIEF (Behavior Rating Inventory of Executive Function) to complete data on information processing. Results: The comparative analysis shows, in terms of information processing, that the control group achieves higher scores in both the overall K-ABC and, the existence of a greater difculty in sequential processing in students with ADHD.The inattentive group show difculties in simultaneous processing of the information, too. Conclusion: We suggest that is necessary to be able to carry out an accurate early diagnosis al school level, especially for those students in the inattentive ADHD group and that there is evidenve of the need to implement differential learning and strategies.

P-12-03 Motivation and interference control in children and adolescents with Attention Decit Hyperactivity Disorder: A research plan I. Ma*, K. H. Putnam, A. Scheres * Nijmegen, The Netherlands Objective: Decits in executive function domains and an altered reward sensitivity are typically thought to be main underlying causes associated with symptoms of ADHD. Most studies have focused on one of these two decits separately. However, daily life often requires one to inhibit responses to stimuli with a certain valence. Therefore, in order to create executive function tasks with a higher ecological validity, we propose the use of stimuli of varied valence. We hypothesize that effect sizes of AD/HD-control differences will increase when such valence manipulations are applied in AD/HD studies. Method: Methods/research plan: Participants aged 9-17 will be included, consisting of three groups (AD/HD-I, AD/HD-C and healthy controls), n= 36 per group. The motivational Stroop task will consist of two conditions, using words related to 1.reward and 2.punishment. The emotional Stroop task will also have two conditions with words related to 1.happiness and 2.anger. Neutral control words will be matched for length and word frequency. Results: Two pilot studies conducted at the University of Arizona have shown that stimuli with a positive valence (words related to reward) indeed caused a higher interference effect, compared to matched neutral words, in a motivational Stroop task. This effect was exacerbated in children and adults with higher levels of AD/HDrelated behaviours. To a lesser extent, negative valence words facilitated interference control.

P-12-05 Children with ADHD show the same pattern of impairment in working and long-term memory S. Rhodes*, J. Park, S. Seth, D. Coghill * Glasgow, United Kingdom Objective: While extensive evidence shows that children with Attention Decit Hyperactivity Disorder (ADHD) show impaired working memory (WM), very limited focus has been given to longterm memory (LTM) functioning. Neuropsychological case dissociations between WM and LTM suggest that WM impairment does not necessarily indicate LTM difculties. The aim of the current study was to determine if children with ADHD show impaired LTM. Verbal and spatial aspects of LTM were examined to ascertain if the well established verbal/spatial WM dissociation in children with ADHD, with greater impairment observed on spatial than verbal tasks, also extends to LTM. Method: Twenty-one drug-nave boys with ADHD (mean age: 9.5) were compared with 26 age matched typically developing (TYP) boys. All ADHD children had undergone comprehensive diagnostic assessment. All children performed verbal and spatial STM and executive WM component tasks. They also completed verbal and spatial LTM recognition and free recall tasks from the CANTAB neuropsychological battery. Results: Children with ADHD showed impaired WM and LTM, but impairment was greater in spatial than verbal functioning across WM and LTM tasks. Verbal WM impairment was selective to an executive WM task and there was no evidence of impairment on verbal LTM tasks. Conclusion: Children with ADHD show impaired LTM, in addition to their well documented WM difculties. Dissociation between verbal and spatial LTM mirrors the pattern of functioning observed on WM tasks showing that spatial memory impairments are a key cognitive feature of ADHD. As verbal and spatial aspects of memory are related differentially to the learning of academic subjects (verbal to literature based subjects and spatial to mathematics and science based subjects) the ndings have implications for educational learning.

P-12-04 The differential aspects of cognitive proles of students with Attention Decit Hyperactivity Disorder ` A. Mies*, A. Fornieles, E. Jurado, M. Quintana * Bellaterra, Spain Objective: The purpose of this study is to analyse the cognitive processes involved in information processing of children with ADHD and to compare them with students of the same age who do not have a manifest disorder. The main objectives are based on assessing the performance in planning and sequencing tasks, and detecting differences and similarities between both groups, according to the results of previous studies in which the scores obtained by students with ADHD tend to be lower in planning, attention and sequential processing (Perez Alvarez and Timoneda, 2001; Fernandez Dean and Dean, 2004). Method: The study sample involves 23 boys and girls ages 8 to 10 years old with ADHD enrolled in public and charter schools and 23children of the same age and academic level without a specic disorder, belonging to the same schools as the study sample. To develop the cognitive proles participants in both groups have made various subtests of the K-ABC (Kaufman Assessment Battery for Children) relating to the type of processing and academic knowledge.There have also administered several questionnaires to the parents such as the SNAP- IV (Swanson, Nolan and Pelham Questionnaire), to classify participants according to the subtype of ADHD,

P-12-06 Higher order theory of mind in preschool boys at risk of ADHD M. Wozniak-Prus*, E. Pisula * Warszawa, Poland Objective: Difculties with impulse control, attentional capacity and hyperactivity hinder social development. Unfortunately only few studies have been conducted on the social problems of preschoolers at risk of ADHD and our knowledge concerning antecedents of social

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141 impairments in hyperactive and inattentive children is limited. One of the posssible explanations is impairment in mentalising skills, but the results of previous studies were inconclusive. The aim of the study was to investigate potential delays in the theory of mind development especially in understanding of emotions and intentions and falsebelief understanding. Method: Participants were 30 boys at risk of ADHD aged 4,56 years and aged-matched control boys. Verbal ability and non-verbal intelligence were controlled. The development of a higher order theory of mind and understanding of emotions were measured by two picture stories. First tells a story of a boy who needs to seek his toy and a subject was asked to answer questions concerning second-order false belief understanding and understanding of emotions and intentions. In the second story a problem of a girl in an unexpected situation has been described. Children were asked to explain the situation and feelings of the character. Results: Statistical analyses concerning between groups comparisions were performed. There were no signicant differences between the groups on the advanced theory of mind measures. Although boys at risk of ADHD explanations about what had happen were fewer positive than control boys. Boys at risk of ADHD had also more problems with answer they refused answering the questions more often than control boys. Conclusion: Outcomes indicate that there is no delay in the theory of mind development in the group of preschoolers at risk of ADHD, but they show different prole of mentalising skills. P-12-08 Working memory decits in Attention Decit Hyperactivity Disorder K. Knight*, A. Scheres * Boulder, USA Objective: Decits in Working Memory are commonly associated with Attention Decit Hyperactivity Disorder (ADHD) and a number of studies have specically implicated updating of working memory. Some research has suggested that the cognitive decits seen in the inattentive subtype vs. the combined subtype might be signicantly different. Therefore, this study assessed the association between various aspects of visuospatial working memory, including updating, and symptoms of inattention and hyperactivity/ impulsivity. Method: This study included 60 adolescents aged 12-17 with varying levels of inattentive and hyperactive/impulsive symptoms, including typically developing controls, ADHD-Inattentive Type (ADHD-I), and ADHD-Combined Type (ADHD-C). To test working memory, we used a visuospatial working memory task in which working memory load varied from a series of 2-9 memory stimuli. At each difculty level, there were the following conditions: no delay or distracter; delay only; distracter only; delay plus distracter. The distracter and delay trials were intended to distinguish between updating vs. maintenance of working memory. The dependent variables for this task are the highest number of correct responses in each condition: (1) no delay, no distracter; (2) delay, no distracter; (3) distracter, no delay; (4) delay and distracter. Results: Preliminary results of 25 typically developing controls and 20 participants with ADHD-I indicated the following: (1) the task manipulation worked: especially on trials with a distracter AND a delay, participants has lower scores than on the other trials; (2) the decrement in working memory performance due to the presence of distracters was larger in the ADHD-I group than in the control group; (3) the decrement in working memory performance resulting from the presence of delays, on the other hand was the same for the ADHD-I and the control group. Conclusion: These preliminary ndings suggest that ADHD-I may be characterized by a specic working memory decit in updating, but not in maintenance.

P-12-07 Sensory processing prole in children with Attention Decit Hyperactivity V. Tiemi Shimizu*, M. Carolina Miranda * Guarulhos, Brazil Objective: The purpose of this study was to assess the sensory processing in children with Attention Decit Hiperactivity (ADHD) based on Sensory Prole (SP), a parent-reporting measure of childrens sensory processing and modulation, besides behavioral and emotional responses in daily life. Method: The clinical group was composed by 37 children from 6 to 11 years old (30 M and 7 F) with a primary diagnosis of ADHD excluding children with neurological disorders (e.g., pervasive developmental disorder, epilepsy, brain lesions, syndromes or prematurity) with intellectual disability and using psychotropic medications or stimulants to treat ADHD. The ADHD group was matched to the control group by age, gender and socio economic conditions, excluding children with signs of hyperactivity/inattention or other development disorders. The sensory responses from both groups were compared by Mann-Whitney U tests and the associations between the Sensory Prole and Child Behavior Checklist (CBCL) scores were examined by Pearson correlation coefcients. Results: Children with ADHD demonstrated statistically signicant differences from children without ADHD in their sensory processing and modulation, besides behavioral and emotional responses as reected in 11 out of 14 section scores (ps\ .0018) and on their sensory responses as reected in 6 out of 9 factors scores (ps\ .001). Scores on the Sensory Prole indicated statistically signicant moderate correlations (r =.30-.49) with scores on the CBCL. Conclusion: The ndings of the present study indicate that children with ADHD may have decits in sensory processing contributing to the impairment in adaptive functioning, including behavioral responses and learning, suggesting the sensory processing as a dimension also being considered and studied as part of the symptomatology of ADHD.

P-12-09 Working memory performance of children with ADHD versus clinical controls J. Lemiere*, E. Rymen, J. Dillen, M. Danckaerts * Gingelom, Belgium Objective: A number of meta-analyses have demonstrated that children with ADHD exhibit signicant working memory (WM) problems. The strongest effect size was found for visuospatial working memory. The aim of the present study was to investigate the sensitivity and specicity of WM problems in a clinical referred sample of ADHD children. Method: Subjects were recruited from the multidisciplinary ADHD outpatient clinic and parents gave informed consent. Exclusion criteria were mental retardation and neurological problems. 170 subjects underwent a comprehensive child psychiatric investigation. This consisted of a standardized protocol: semi-structured interview, Child behaviour checklist, social communication questionnaire, Highfunctioning autism spectrum screening scale. The working memory tasks consisted of a digit span task (from children memory scale) and a visuospatial span task (from the working memory battery test for children). 99 children received a diagnosis of ADHD, 27 another DSM-IV diagnosis, 44 no DSM-IV diagnosis MANOVAs were

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142 conducted to test whether the ADHD group performs worse than the clinical control group. Results: No group differences were found, but the scores for the total group were signicantly below the average score from the general population. Post hoc analyses demonstrated some differences between the 3 groups. Additional analyses are planned to investigate the role of age, sex, comorbidity. Conclusion: The preliminary results of the present study suggest that WM problems are present in a clinical referred sample, irrespective of the type of diagnosis. These results and additional data will be presented. assessment involved 205 children aged 7 to 14 referred to NANI at UNIFESP with complaints of attention difculties and/or hyperactivity. Method: They were assessed by a multidisciplinary team and a battery of neuropsychological tests: DSM-IV criteria, Continuous Performance Test (CPT), ve subtestes from Automated Working Memory Assessment (AWMA), Behavior Rating Inventory of Executive Functions (BRIEF), Child Behavior Checklist (CBCL) and Child Behavior Evaluation Scale for Teachers (Conners Scale). Results: 116 children (88 M and 28 F) fullled the criteria for ADHD, among which 45 were of the inattentive type, 59 of combined type and 12 were hyperactive/impulsive. There was negative correlation between the digit score and the Corsi test, especially in reverse order. Children with high scores for hyperactivity and impulsivity had a low performance for functional memory. Children with oppositional deant disorder presented pattern changes in adaptability when there was a change in the rhythm the stimuli were presented and lower adaptation to time variability (Hit RT), in addition to higher rates of omission in the CPT. Conclusion: This study suggests multiple interrelations between the scores of neuropsychological battery, which are useful for a more detailed delimitation of the clinical prole of children with ADHD in order to select better approaches in a cognitive rehabilitation program.

P-12-10 Analysis of affective disorder in children with Attention Decit Hyperactivity Disorder - ADHD by Rorschach Test R. Figaro*, C. A. Araujo, M. Muszkat, M. C. Miranda, S. Rizzutti, S. M. M. Palma, L. F. Coelho, F. Dias, O. F. A. Bueno * Sao Paulo, Brazil Objective: This study investigated the affective characteristics of children with Attention Decit Disorder and Hyperactivity Disorder (ADHD) combined type (study group) after neuropsychological assessment and multidisciplinary, comparing them to children who had no disorder (control group) by the Rorschach Test, as the Exner Comprehensive System. Method: The groups were composed of 30 children between 6 and 10 years of age. In the study group participated 93.3% of male children and 6.7% of female and in the control group 86.7% were female and 13.3% male. We applied the descriptive quantitative methodology, using the theoretical framework of Analytical Psychology, to draw inferences about the emotional development of children with ADHD. We evaluate the variables of Affect Module, including the variables Lambda, Note D and Adjusted D (ADJ D), experience-based (eb), style of living extratensive (EB), that compose the Module of Control and Stress Tolerance and Positive Constellations, which may indicate the presence of psychiatric disorder. The answers were classied and coded by three judges. A comparison between groups was analyzed statistically with t test for independent samples and Fishers test for dependent samples. Results: The disorder group showed greater susceptibility to depressive disorders, difculties in inhibitory control related to permanent stress, intense ideational activity, undermining the processes of attention and concentration when compared to control group. Conclusion: Children with ADHD have affective characteristics that distinguish them from others regarding the ability to feel pleasure. Invaded by unpleasant and painful feelings, have insufcient resources to manage psychological stress. They experience feelings of loss of control that affect the course of deliberate thoughts, ideations intense activity taking place, which creates discomfort and interfere with attention and concentration. This study suggests that treatments include strategies to alleviate the emotional pain that they present.

Friday, 27 May 2011, 14.3016.00 P-13 Pathophysiology: Children and adolescents II

P-13-01 Symptoms of Attention Decit Hyperactivity Disorder in children: Differential effects on response inhibition? L. Srensen*, J. Plessen, S. Adolfsdottir, E. Wehling, A. J. Lundervold * Bergen, Norway Objective: Children with Attention Decit Hyperactivity Disorder (ADHD) have problems inhibiting responses, which predominantly seem to be inuenced by symptoms of inattention (Willcutt et al., 2005). The concept of response inhibition, however, comprises different subfunctions, also including interference control and behavioral inhibition (Friedman & Miyake, 2004; Nigg, 2000). The present study investigated if ADHD symptoms of hyperactivity/impulsivity and symptoms of inattention have a differentiated impact on these two subfunctions in children selected from a population-based sample. We hypothesized that symptoms of hyperactivity/impulsivity would show the highest contribution in explaining performance on tests of behavioral inhibition, whereas symptoms of inattention primarily would contribute to explain performance on tests of interference control. Method: A sample of 253 children aged 8 to 11 years participated in the Bergen Child Study. Children were tested on psychometric measures of response inhibition (i.e. behavioral inhibition: commissions score from Conners0 Continuous Performance Test II (CPT); Interference control: Interference score from Stroop Color Word Interference Test (Stroop) and Conict score from Attention Network Test (ANT)). In addition, parents of the children lled in a questionnaire asking of ADHD symptoms (according to DSM-IV symptom criteria for ADHD). Results: Multivariate effects of symptoms of inattention and hyperactivity/impulsivity were revealed. Symptoms of inattention showed a statistically signicant impact on the interference score from Stroop in the univariate analyses, whereas hyperactivity/impulsivity symptoms inuenced the commission score from the CPT and the conict score from the ANT.

P-12-11 Clinical and neuropsychological prole in a sample of children with Attention Decit Hyperactivity Disorders (ADHD) S. Rizzutti*, L. F. Coelho, S. M. Mota Palma, R. Figaro, D. Barbosa, F. Dias, M. Miranda, O. F. A Bueno, M. Muszkat * Sao Paulo, Brazil Objective: The aim of this study was to evaluate clinical and neuropsychological ndings in children with suspicion of ADHD. The

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143 Conclusion: Findings in the present study supported the hypothesis that symptoms of hyperactivity/impulsivity contribute to problems in behavioral inhibition, whereas inattention contribute to problems in solving tasks measuring interference control. Method: Of all 55 ADHD children, 34 children was ADHD, combined type (ADHD-C), and 21 were ADHD, predominantly inattentive type (ADHD-I). Neuropsychological tests to measure cognitive function (WISC-R), executive functions (ROCF, CCTT, Stroop, WCST), and attention(CPT) were individually administered to children. And the estimated scores of those tests were calculated based on the age norm for each test. Results: There were no signicant differences in FSIQ, VIQ, and PIQ between the two groups. However, ADHD-I group tended to show higher scores on the subtest of Coding. In terms of inhibition, there was no difference between two subtypes of ADHD children. But ADHD-I group showed higher prompt errors on CCTT-2 than ADHD-C group children. The ADHD-C group scored signicantly lower on cognitive exibility, but higher on planning scores in WCST than ADHD-I group. Conclusion: The ADHD-I children also have inhibition problems like ADHD-C children. The ADHD-C children have better planning ability, but have less cognitive exibility than ADHD-I children.

P-13-02 Selected executive functions in ADHD diagnosed children M. Dabkowska*, W. Chytra-Gedek, M. Mitros * Bydgoszcz, Poland Objective: The study evaluated a selection of cognitive functions in ADHD diagnosed children in relation to age and gender and to anxiety disorder diagnosed children. The examined group was composed of 29 children with ADHD. The majority of children were boys - 22 and only 5 girls. Among 29 children, the diagnosis of the combined subtype ADHD was the most frequent 86%, only 14% of the predominantly inattentive subtype. The same cognitive functions in ADHD diagnosed children were compared to results of neuropsychological tests in 43 anxiety disorder diagnosed children (26 boys and 17 girls). Method: I. Neuropsychological evaluation: TMT A&B (Trail Making Test A & B) and Stroops Test (Colour-Word Perseveration Test). Trail Making Test comprises two parts. Part A evaluates psychomotor speed, and part B examines visuospatial working memory and set-shifting ability after learning one rule of conduct. Good visuomotor coordination is an advantage. Tests result is provided in seconds (tasks are timed). Stroops Test is used to assess verbal working memory and attention span and comprises two parts: RCnb (reading colour names in black) and NCWd (naming colour of word-different). The test assesses perseveration and during its second part a previously studied criterion needs to be neglected and substituted with a novel criterion, with the former one still present. Tests results are based on completion times of parts one and two, and on the number of perseveration mistakes made during part two. II. Evaluation of presence and intensity of ADHD: ADHD was diagnosed in agreement with the DSM IV TR research criteria. The parents evaluated the intensity of particular symptoms of the Attention Decit Hyperactivity Disorder by means of the ADHD Rating Scale questionnaire IV version for parents. Results: Analysis of results indicates that children with ADHD need signicantly more time to perform NCWd part of Stroop Test and B part of TMT. The results did not reveal signicant differences in selected neuropsychological tests performance between the boys and the girls with ADHD. ADHD younger subjects performed worse on the Stroops Test and TMT A&B; younger age correlated with longer completion time of tests. Conclusion: Selective cognitive functions signicantly distinguish between children with ADHD and children with anxiety disorders. In the research on children with ADHD the use of tests and neuropsychological trials designer for evaluation of executive functions is justiable.

P-13-04 Visuospatial abilities in children with and without Attention Decit Hyperactivity Disorder H. Alizadeh*, S. Dehghan Manshadi * Birjand, Iran Objective: This study examines visuospatial ability in children with and without Attention Decit Hyperactivity Disorder (ADHD). Also, a comparison was done on the ADHD subtypes and the visuospatial abilities. Method: In this causal-comparative research, through a cluster random sampling technique, 80 students ageing 8 to 10 (60 with and 20 without ADHD), were recruited. In the ADHD group, 20 children were Inattentive subtype, 20 were hyperactive-Impulsive subtype, and 20 were Combined subtype.Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (2000) criteria for ADHD diagnosis, and Kohs Blocks Design Test for visuospatial abilities, were utilized to collect the data. Results: One-way ANOVA revealed a signicant difference between the two groups of with and without ADHD. Furthermore, a signicant difference was found among the subtypes. Conclusion: Accordingly, we can suggest that weaker visuospatial abilities in ADHD children may be related to their nonverbal problems, and be helpful for intervention programs.

P-13-05 A comparison of childrens attention and cognitive function across noise conditions a randomized controlled study S.-Y. Bhang*, J. Lee, C. Lee, J. Yoon, C. Shim, J. Sung * Ulsan, Republic of Korea Objective: The purpose of this study was to investigate the impact of environmental noise on attention and cognition in elementary school students while controlling for various confounders. Method: From November 15th, 2010 to December 8th 2010, 268 students from three elementary schools (135 boys, 133 girls, 10-12 years old) in Ulsan city, Republic of Korea were enrolled in this study. With respect to experimental design, we divided the students into two groups: 1) Noisy environment group (N) was given an additional 15-17 dB compared with the ambient background noise in the school; 2) Control environment group (C) was given background noise as existed in the school.We used the abbreviated form of the Wechsler Intelligence Scale for Children, the Stroop Color-Word Test

P-13-03 Comparison of neuropsychological functions in subtypes of children with ADHD M.-S. Shin*, J.-K. Ahn * Seoul, Republic of Korea Objective: This study was conducted to investigate differential characteristics of neuropsychological functions, especially in executive functions between subtypes of ADHD.

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144 (STROOP), the Childrens Color Trail Test (CCTT), and a computerized continuous performance test (CPT). Results: After adjusting for socio-demographic covariates, multiple general linear regression analysis showed that noise exposure was signicantly and negatively associated with CPT scores: 1) the response time on the auditory selective attention test (85.19 for C group vs. 91.51 for N group, p=0.007), 2) the omission error and response time on the divided attention test (92.98 for C group vs. 86.01 for N group, p=0.034; 98.84 for C group vs. 104.72 for N group, p=0.047; respectively), and 3) the forward memory span and forward correct response on the spatial working memory test (96.80 for C group vs. 91.42 for N group, p=0.045; 95.21 for C group vs. 89.23 for N group, p=0.020; respectively). Also, the full-scale IQ scores (116.71 for C vs. 109.68 for N, p\0.001) and verbal IQ scores were negatively associated with the existence of experimental noise. On the CCTT and STROOP tests, CCTT-1 total time (20.51 for C group vs. 22.50 for N group, p=0.021) and word score (50.82 for C group vs. 48.22 for N group, p=0.030), which both represent reading speed, were negatively associated with the experimental noise, respectively. Conclusion: Thus, it is suggested that noise (more than 15 dB higher than background) is hazardous to attention and performance in elementary school students. Further study of the broad line level of noise is needed with respect to the positive effect and negative impact on cognitive function. support visual attention (e.g., exposure time, color and valence intensity) on REFE in children with ADHD. We hypothesized that attention-supported exposure conditions would enhance REFE in children with ADHD to the level of the controls. Method: A cross-sectional study with repeated measures in two contexts (N=79, 2/3 males, aged 15 2.5 y, typical IQ) compared REFE performance of children with ADHD and controls as a function of three independent factors: color [natural colors (C) vs. black & white (B&W)], exposure time (200 ms vs. 600 ms) and valence (low, moderate, high). 96 stimuli from 6 emotions: happy, sad, worried, angry, surprised, and disgusted (Matsumoto et al., 2000) were randomly displayed in 2 genders, 2 colors and 2 exposure-time conditions. Additionally, 36 comparable stimuli were presented in 3 valence levels. Results: MANOVA with repeated measures showed that children with ADHD erred more frequently on the least supported condition (B&W-200 ms, p\0.001) and on the low and moderate intensity stimuli (ps\0.05); Effects sizes rose from 2% in the C-600 ms condition, to 9% for B&W-200 ms. They also took longer to respond to most conditions (B&W, Low and high valence (ps\0.05) and C-600, p\0.001). For the most part there were no specic emotion ndings, indicating attention-bias rather than specic emotion insensitivity. Regression modeling showed that reaction times were positively related to Achenbachs social problems index in children with ADHD (p\0.05). Conclusion: Data support the relations between speed of social information processing and social adaptation in ADHD. Results may contribute to the development of a REFE-based intervention to improve interpersonal relations in children with ADHD.

P-13-06 Neuropsychological functioning in clinical subtypes of drug nave girls with Attention Decit Hyperativity Disorder C. Paloscia*, R. Alessandrelli, C. Rosa, A. Pasini * Rome, Italy Objective: Very little is known about the neurocognitive functions of young females with Attention Decit Hyperactivity Disorder (ADHD). This study examined the relationship between attentionexecutive impairment and clinical subtypes of ADHD in a sample of young girls. Method: The research included 30 girls with ADHD between the ages of 7 and 14 and 35 controls in the same age range. All subjects performed both a clinical-psychopathological and a neuropsychological test battery. Five main domains of executive functions (EFs) and attention were studied. Executive function-related neurocognitive abilities were used as control tasks. Results: All ADHD patients and inattentive and combined subtypes differed from controls regarding response inhibition, divided attention, working memory and planning. Comparison of ADHD subtypes in ve main EF domains showed no evidence of different executive function proles. Conclusion: Data revealed that girls neuropsychological prole was comparable to boys. In particular, our results conrm that in young females there is no difference in neurocognitive performance between ADHD combined and ADHD inattentive subtypes.

P-13-09 Investigation of the relationship between executive functions and theory of mind in Attention Decit Hyperactivity Disorder H. Slama*, P. Mousty, P. Peigneux, I. Massat, A. Mary * Brussels, Belgium Objective: Besides behavioural symptoms, Attention Decit Hyperactivity Disorder (ADHD) characterizes by cognitive impairments, mainly in attentional and executive functions (EFs), and socio-emotional difculties possibly linked with decits in Theory of Mind (ToM). In this study, we probed the relationship between ToM and EFs in ADHD. Method: Twenty-two children with ADHD (8-12 years, IQ[85). and twenty seven matched healthy controls participated in this study. Assessment and differential diagnosis were carried out using the Kiddie-SADS and the DSM IV criteria. We assessed ToM with two tasks involving different levels of executive control: the Reading the Mind in the Eyes (RME) task (low executive demands), and the Faux Pas (FP) task (higher executive demands). Participants were also administered a large cognitive battery, mainly assessing EFs (inhibition, planning and exibility), working memory (WM) and attention. ANOVAs, Pearsons correlational analyses and linear regression analyses were performed on behavioural data. Results: ADHD children showed impaired performance as compared to controls in WM, attention and EFs. Concerning ToM, ADHD children performed more poorly than controls in FP task (F(1,47)=5.49, p=0.02) and in RME task (F(1,48)=6.57, p=0.01). Pearsons correlational analyses were computed between ToM and EF in our 2 groups. In the control group, ToM was correlated with tasks involving WM, attention, exibility and inhibition. In the ADHD group, ToM was correlated with tasks involving WM, attention, inhibition, planning and exibility. Linear regression analyses in ADHD group indicated that FP task was best predicted by inhibition, exibility and planning and RME task by exibility and attention.

P-13-08 Attention supporting conditions enhance recognition of emotional facial expressions (REFE) in children with ADHD R. Geva*, D. Tamari * Ramat Gan, Israel Objective: Interpersonal deciencies are a central component of ADHD. Perceptual decits in recognition of emotional facial expressions (REFE) have been recently proposed as the mechanism involved. The aim was to examine the effect of conditions that

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145 Conclusion: Our results yield evidence for ToM decits in ADHD children. Correlation and regression analyses suggest a close link between performance on ToM and EFs tasks, but also with attention. Altogether our results corroborate the hypothesis of ToM alterations in children with ADHD possibly linked with EFs decits, which may contribute to the socio-emotional difculties frequently experienced in this population. and interaction. The difference in combined l scores was signicant at one tail. For the paper and pencil dual-task were not found signicant effects. The signicant test-retest reliability was found for the computerised and paper and pencil l scores and correlation between two types of tasks. Conclusion: The dual-task coordination is available in children/ adolescents with ADHD in general and in its subtypes as in age and years of education matched NC.

P-13-10 Fluency strategies in ADHD: language-based compensatory behavior in task solving A. Takacs*, A. Kobor, Z. Tarnok, V. Csepe * Budapest, Hungary Objective: Fluency tasks (verbal and nonverbal) are commonly used in cognitive and developmental neuropsychology in assessing executive functions, language skills or divergent thinking. The current Attention Decit Hyperactivity Disorder (ADHD) research produces ambiguous results when uency tasks are used. However, the additional use of qualitative (switching, clustering and complexity) scoring may clarify the possible background of various achievements indicated so far. Method: 22 typically developing children and 22 children with ADHD (8-12 years old) were examined by using the Verbal Fluency and Design Fluency tasks of NEPSY-I (Hungarian version, used by permission for research purposes only) and other neuropsychological measurements. Results: The main difference between the two groups was found in the subjects performance time that related to difculties in strategy using; where children with ADHD had a time lag in applying relevant lexical or executive strategies. However, when agglomerative hierarchical cluster analyses was performed, a compensating group performing better in the Verbal Fluency task was identied. This advantage could not be used whenever the relevant language skills were not available to solve the test, so that children with ADHD could not lean on compensatory mechanisms. Conclusion: Our results underline the impact of cognitive approach on developing and using complex neuropsychological tasks including language-based components relevant in the clinical diagnostics of ADHD. A better detection of compensatory mechanisms playing a possible role in overcoming the decit is crucial. It is of particular importance to know all those atypical but efcient ways in problem solving (not just in the uency tasks) that are usable in treatment relying on effective and complex methods. However, further studies are needed to nd the latent factors contributing to compensation present in the performance of ADHD children.

P-13-12 A qualitative study on the effects of silently-whispered and/or softly-pronounced vs loud and serious verbal instructions during occupational therapy sessions on an iranian sample of children with Attention Decit Hyperactivity Disorder S. Nakhai*, F. Behnia * Tehran, Iran Objective: Research shows that children with Attention Decit Hyperactivity Disorder (ADHD) nd it hard to ignore environmental sounds and are easily distracted by them when doing a task, while the effects of task-relevant sounds have barely been studied. We compared silently-whispered and/or softly-pronounced verbal instructions to loud and serious ones during occupational therapy(OT) activities for ADHD children to see whether task-relevant sounds (here, therapists voice) could also have negative effects on the symptoms. Method: 24 ADHD children referred to the OT clinic by child psychiatrists received OT, half of them with silently-whispered and/or softly-pronounced verbal instructions (G1=12) while the other half with normally loud and serious verbal instructions (G2=12). Their parents joined family group discussions once every three sessions. During family discussions the childs problems and improvements were discussed. After 20 sessions a nal family group discussion was held to see if the parents of the two groups reported any difference. we also asked the psychiatrists their professional opinions about each child. Results: According to parents, both groups improved but G1 showed more improvement than G2. They showed wider attention spans and higher concentration levels. G1 parents reported more purposeful and adaptive behaviors, ability to follow instructions, obeying rules, selfentertaining with functional activities for a longer time, more concentration while doing homework, decrease in impulsive behaviors and emotional overreactions. The psychiatrists were satised with improvements of both groups, but were specically pleased with G1s improvements and in some cases lowered or stopped the medication dosage for G1. Conclusion: This study shows that not only environmental (taskirrelevant) sounds but also task-relevant ones could negatively affect ADHD children. Although further research is necessary, but our results could open new doors to therapeutic techniques for ADHD children, like suggesting parents, teachers, and therapists speak softly and quietly to them with lower than normal voice.

P-13-11 Is dual task coordination available in ADHD? K. Inasaridze*, V. Bzhalava, L. Chikvaidze * Tbilisi, Georgian Objective: The study aimed at dening the dual-task performance in control and ADHD children on the computerised and the paper and pencil dual-task methods. Method: The 6-16 years old 91 controls and 91 ADHD children matched on age, years of education and WISC-III were studied. The ADHD and its subtypes have been diagnosed with the DSM-IV. The computerized and paper and pencil (Tbilisi paper and pencil motor task) versions of the dual-task were used. Results: For the computerized tracking task there was signicant effect of type of task, of group and interaction. For the List Memory Task was found signicant effect of type of task, no effect of group

Friday, 27 May 2011, 14.3016.00 P-14 Pathophysiology: Adults I

P-14-01 Self-report of executive function decits and self-concept in adults with ADHD R. Drechsler*, P. Rizzo, H.-C. Steinhausen * Zurich, Switzerland

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146 Objective: A positive illusory bias in the perception of difculties has been reported by several studies for children with ADHD. Whether self-report on cognitive functioning is biased or realistic in adults with ADHD, is still matter of debate. Method: Adults with ADHD and normal control subjects, matched pairwise for age, gender and profession, completed self-report questionnaires on executive function decits (Dysexecutive Questionnaire DEX) and on self-concept (Frankfurter Selbstkonzeptskalen FSKN). ADHD patients and controls were also rated on the DEX by a signicant other. Results: Adults with ADHD rated themselves as signicantly more impaired in executive functioning than controls. Compared to ratings by signicant others, self-reports of adults with ADHD were accurate or tended to over- rather than to underestimate executive function decits. This tendency was also found in controls. Although adults with ADHD displayed generally more negative self concepts than controls, their ratings of emotional and interpersonal facets of selfconcept were unrelated to self reports on executive functions. In control subjects, in contrast, these facets of self-concept were correlated with self-report on cognitive failures. Conclusion: Adults with ADHD seem to perceive cognitive problems in everyday life adequately. Their cognitive complaints appear unrelated to general negative self concept. This does not support the assumption of a general positive illusory bias in adult ADHD. P-14-02 Utility of the INECO Frontal Screening (IFS) for the detection of executive dysfunction in patients with adult ADHD and bipolar disorder B. Sandra*, E. Gleichgerrcht, H. Urquina, A. Lischinsky, M. Roca, F. Manes, T. Torralva * Buenos Aires, Argentina Objective: Adult Attention Decit Hyperactivity Disorder (ADHD) and bipolar disorder (BD) share several clinical symptoms and present high rates of comorbidity. Cognitive difculties in both disorders are mostly present in the executive domain. The detection of executive dysfunction usually requires the administration of an extensive neuropsychological battery, as there are few screening tests specically designed to evaluate executive functions. The INECO Frontal Screening (IFS) is a solid and brief tool, which has proved useful for the assessment of the executive functions in patients with dementia. The aim of this study was to assess the utility of the IFS to detect executive dysfunction in ADHD and BD patients. Method: 20 ADHD patients, 20 BD patients and 26 controls (matched for age, sex and years of education), were assessed with a neuropsychological battery that included the IFS and classical executive tests. Results: Both clinical groups showed signicantly lower scores than controls on the IFS total score and on the spatial working memory subscale. Performance on the abstraction capacity subscale was signicantly lower in ADHD compared with controls. The IFS total score correlated signicantly with several executive tasks (phonological uency task, Trail Making Test- B, digits backward span, letters and numbers sequencing, arithmetic and commission errors on Go- no go task). Conclusion: The IFS is a solid and useful tool for the detection of executive dysfunction in ADHD and BD patients. P-14-03 Classication of ADHD and healthy control adults using event-related potentials and independent component analysis A. Muller*, G. Candrian, J. D. Kropotov, G. M. Baschera, V. Arntsberg Grane, V. Ponomarev * Chur, Switzerland Objective: In the context of sensory and cognitive-processing decits in ADHD patients, there is considerable evidence of altered eventrelated potentials (ERPs). Most of the studies, however, are limited to group differences in children. By means of independent component analysis (ICA), ERPs can be decomposed into functionally different components. Using the classication method of support vector machine (SVM), this study investigated whether features of independent ERP components can be used for separating ADHD adults from healthy subjects. Method: Two groups of age- and sex-matched adults (75 ADHD, 75 controls) performed a visual two stimulus go/nogo task. ERP responses were decomposed into independent components by means of ICA. A feature selection algorithm dened a set of independent component features which were used for SVM classication. Predictive power of the SVM classier was validated using an independent sample of 17 ADHD adults from a different laboratory. Results: The feature set, composed of a combination of ve features with best classication performance, predominantly consisted of latency measures collected from four different independent ERP components. Using a 10-fold cross-validation approach, classication accuracy was 91%. Moreover, 94% of the independently diagnosed ADHD subjects were correctly classied as having ADHD. Amplitude and latency measures differentiating best between ADHD patients and non-clinical subjects primarily originated from independent ERP components associated with inhibitory and noveltyrelated processes. Conclusion: Classication by means of SVM on the basis of ERP data is feasible in the context of clinical groups. Furthermore, independent ERP components have been shown to provide features that can be used for characterizing ADHD adults. The project aims for a more objective diagnosis of ADHD in clinical work. As a next step, differential diagnostic categorization of patients is to be investigated.

P-14-04 Frequency and dental consequences of bruxism in adults with Attention Decit Hyperactivity Disorder (ADHD) M. A. Silva*, L. M. D. Aguiar, E. F. O. Firsoff, C. M. Agra, M. Louza, G. F. Vieira * Sao Paulo, Brazil Objective: To investigate the frequency and dental consequences of bruxism in adults with ADHD. Method: Thirty seven adults with DSM-IV criteria of ADHD were included; 20 males and 17 females, median age of 37.5 years (22 to 63 yo). All subjects were investigated for the occurrence of bruxism before they initiated the use of psychostimulants. The diagnosis of bruxism was established using questionnaires and clinical-dental examination (presence of worn facets, occlusal interferences, gengival regression, local dental pain, midline relationship, facial asymmetry, limitation of mouth opening, presence of disocclusion guides, presence of noises, muscle pain, and behavior of the condyle during mandibular movements). Results: The frequency of bruxism in the ADHD group was 97.3%. The most commom ndings were: worn facets (78.4%), dental grinding (78.4%), abfraction (67.6%), muscle pain (78.4%) and headache (51.4%). Conclusion: Bruxism is highly prevalent in the ADHD population, in comparison to the general population (8 to 20%)1,2. To prevent oral health problems related to bruxism, patients with ADHD should be referred to dentists. Dentists should also consider the possibility of ADHD in patients who present with oral signs and symptoms of bruxism. References: 1. Lavigne GJ, Khoury S, Abe S. et al. Bruxism physiology and pathology: an overview for clinicians.

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147 J. Oral Rehabilitation, 2008, 35;476-494 2. Lavigne GJ. Neurobiological mechanisms involved in sleep bruxism. CROBM 2003, 14(1):30-46. investigated performance in the GDT after boredom induction in a subset of the sample. Differences in the behaviour inhibition (BIS) and behaviour approach system (BAS) as well as cognitive exibility were also assessed. Results: We found that patients with ADHD make risky decisions signicantly more often than the controls and selected the disadvantageous alternatives without using feedback propitiously. Their ctive money loss was higher than in the control group. After boredom induction such a difference between ADHD patients and controls was not longer signicant. Conclusion: Adult ADHD patients show signicant decits in decision making under risk. These decits mirror the disadvantageous daily decision-making behaviour and may be important for the outcome of patients with ADHD.

P-14-05 Neuropsychological assessment of executive functions and psychology prole in adult with ADHD B. Rubio*, J. Bravo, S. Hernandez, P. Gonzalez Perez * La Laguna, Spain Objective: ADHD in children is one of the most studied childhood disorders. However, there are relatively few studies of the clinical and neuropsychological prole of adults with ADHD. The aim of this study is to provide new insights in this area by studying the executive functioning and the psychological prole among a group of adults with ADHD and a control group. Method: Subjects: 9 adults with ADHD (Xage=29.78; SDage=8.51) and 9 healthy control subjects (Xage=29.33; Sdage=8.87) were evaluated. Materials: The neuropsychological set included: Paced Auditory Serial Addition Test (PASAT); Digit subtest (WMS-III) visual Span (WMS-III), Tower of Hanoi Test Stroop; Test of the Wisconsin Card Sorting (WCST); Controlled Oral Word Association Test (COWAT), Continuous Performance Test, Trail Making Test. The psychological prole was assessed by the Questionnaire of 90 Symptoms (SCL-90). A factorial design was implemented, with the independent variable Group (ADHD, Control) and the dependent variable test performance. Results: Differences in verbal working memory and sustained attention were found. Scores between both groups for the rest of the tests used to assess executive performance were similar. The psychological prole meassured by SCL-90 showed signicant differences beetwen both groups. Symptoms in all items except somatization were present in the ADHD group, but not in the control group. Conclusion: These results suggest that the ADHD subjects developed compensatory cognitive-behavioral strategies allowing normal performance in the executive functions that were assessed. However, these strategies appear to be insufcient to cope with real-life situations. The higher rates of psychopathology might partially explain the persistence of difculties arising from nuclear symptoms, where planning, problem solving and inhibition decits, might lead to the typical prole of personal, family and work problems in the course of their life.

P-14-07 Emotion regulation by the use of mindfulness instruction in adult Attention Decit Hyperactivity Disorder S. Matthies*, J. Svaldi, C. Sadohara, P. Borel, A. Philipsen * Freiburg, Germany Objective: Emotion dysregulation even though not a criterion of current ofcial diagnostic systems for Attention Decit Hyperactivity Disorder (ADHD), is since the publication of the Utah criteria by Wender a recognized and clinically important symptom of adult ADHD. The aim of this study is to investigate the impact of specic emotion regulation strategies on adult ADHD symptoms. Method: Thirty-nine adult participants diagnosed with ADHD und 35 age matched control participants were randomly assigned to one of two emotion regulation strategies. One group was instructed to apply suppression of the arising emotion; the other was instructed to apply mindfulness. Participants then watched a short sadness-provoking lm, and estimated current levels of subjective emotion-related ADHD symptoms (internal restlessness, boredom, irritability and emotional overow) as well as the intensity of the inducted emotion before, immediately after and two minutes after the lm using visual analog scales. In addition difculties in emotion regulation were assessed with the DERS (Difculties in Emotion Regulation Scale) to investigate the relation between emotion regulation difculties/preferences and the inducted sadness intensity as well as aforesaid symptoms. Results: First, ADHD patients perceived more difculties in emotion regulation than controls. Second, the ADHD symptoms in the ADHD group were intensied via sadness induction, but not in the control group. Third, the patients0 ADHD symptoms were reduced in the mindfulness condition after two minutes, whereas symptoms persisted in the group which applied suppression of emotions. Fourthly, a preference to suppress emotions was associated to persistence of ADHD symptoms after sadness induction in the ADHD group. Conclusion: In this study ADHD patients had more difculties in emotion regulation than controls. Emotion suppression was associated to sadness intensication and persistence of ADHD symptoms in the ADHD group. Mindfulness appeared to be an effective strategy for ADHD patients to regulate sadness and emotion-related ADHD symptoms.

P-14-06 Performance in the game of dice task in adults with ADHD S. Matthies*, J. Svaldi, C. Nober, A. Philipsen * Freiburg, Germany Objective: Risky decision making and disadvantageous choices are considered a core characteristic of patients with Attention Decit Hyperactivity Disorder. Fronto-striatal dysfunction as well as imbalances in catecholaminergic and dopaminergic pathways may be neurobiological correlates of impulsive namely risky decision making behaviour in these patients. To further understand these behaviours in adults with ADHD we wanted to experimentally assess decision making with the Game of Dice Task (GDT). Method: In this laboratory study, 29 adult patients with ADHD according to DSM-IV criteria and 29 control probands were compared in the GDT. The GDT is a well established decision-making task explicitly providing rules for gains and losses and feedback after each choice. The task assesses decision-making under risk. In addition we

P-14-08 Adult ADHD and sensation seeking T.-L. Austin* * Johannesburg, South Africa Objective: A study by Faraone, Kunwar, Adamson and Biederman (2009) provides some evidence that those who have been diagnosed with adult Attention Decit Hyperactivity Disorder (aADHD) show

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148 specic personality traits, amongst which, novelty seeking, can, arguably, be seen as a characteristic of both sensation seeking and aADHD. Zuckerman maintains that sensation seeking, as a construct, is normally distributed in the population and that one may nd individuals on both ends of the spectrum (i.e. low and high sensation seekers), however, given the behavioural symptoms reported in aADHD one could argue that adults with ADHD would be more prone to high sensation seeking, or vice versa. The aim of this study was to establish whether levels of sensation seeking are higher in adults with ADHD than adults who do not suffer from ADHD. Method: 402 young adults (1825 years) were recruited by various means. All the participants were required to complete the following questionnaires: Internal Restlessness Scale (IRS), Current Symptoms Scale (CSS), Adult ADHD Self-Report Scale(ASRS), Wender Utah Rating Scale (WURS) and the Brief Sensation Seeking Scale (BSS). Results: The results of a multiple regression analysis that was performed on the data indicate that it is inaccurate to view ADHD as a single construct, and correlate this with sensation seeking. It was found that a history of ADHD in childhood, combined with a history of Oppositional Deant and Conduct disorders are the best predictors of sensation seeking. ADHD, in the absence of childhood conduct problems, has no signicant relationship with sensation seeking. Conclusion: The ndings, reported above, are promising as it seems as if there is a shared neurological substrate for sensation seeking and ADHD with conduct problems. Based on these results, the next step in this research will be to conduct an EEG study in order to look at the cortical arousal of the frontal lobe when participants are presented with specic stimuli, which may or may not elicit sensation seeking tendencies, in turn measuring their impulse control capabilities. Because there is a relationship between sensation seeking and ADHD, there may very well be correspondence in the brain structures that are involved, hence, the nal step will be to conduct an fMRI study in order to investigate the brain structures involved in both ADHD and Sensation Seeking physiological responses, lability/impulsivity, irritability, mistrust/ defensiveness, behavioral inhibition and explosiveness. The EBS is a 36-item measure of sensation seeking, including 4 subscales: Novelty, Thrill and Adventure seeking, Interpersonal and Romantic/sexual. Spanish- and English-language versions have been validated in crosscultural studies in Puerto Rico and Australia. Results: Correlations among the subscales of the WURS, the EE and EBS are examined to clarify how the specic dimensions of reactive inhibition, emotional regulation and ADHD symptoms and behaviors are related to each other. Conclusion: Clinical and research implications are discussed.

P-14-10 Emotional reagibility and working memory performance - differential effects of emotional interference control in subjects with and without ADHD I. Marx*, G. Domes, C. Havenstein, C. Berger, L. Schulze, S. C. Herpertz * Rostock, Germany Objective: In a number of studies, it has been shown that subjects with ADHD show decits in executive functioning, i.e. in cognitive functions that subserve planning, monitoring and control of goal-directed behaviour, as well as in emotion regulation. However, no study exists so far examining the interaction between cognition and emotion regulation in subjects with ADHD. In our study, we aimed to examine to what extend arousing emotional picture stimuli may account for differential effects in performance quality in subjects with and without ADHD. Method: Thirty-nine males and females with ADHD aged 18 to 40 years and 40 matched controls performed a working memory n-back task (1-back, 2-back). The task was performed with and without neutral and negative background pictures from the International Affective Picture System (IAPS) which varied in arousal (low, medium, high). Results: Irrespective of ADHD diagnosis, all subjects demonstrated lower performance accuracy in the 2-back condition compared with the 1-back condition. In comparison to healthy controls, subjects with ADHD displayed a decit in working memory performance in terms of decreased performance accuracy. Beyond this, we found that whereas healthy controls did not display performance decits until they were presented with high-arousal background pictures, subjects with ADHD were already impaired when presented with mediumarousal background pictures. Conclusion: Beyond the cognitive distractibility that has been reported in the literature, subjects with ADHD seem to be unusually sensitive to emotional distractors. The implications of these and further ndings will be discussed.

P-14-09 Attention Decit Hyperactivity Disorder, reactive inhibition and emotional regulation in Puerto Rican adults T. Ilarraza*, M. Velez Pastrana, M. Rivera, J. Rodriguez * San Juan, Puerto Rico Objective: This study examines the relationship between emotional regulation, reactive inhibition and characteristics related to ADHD in adults. We seek to shed light on the processes of self-regulation by examining the associations between the expression/inhibition of anger and sensation seeking traits, as they relate to symptoms and behaviors present in ADHD. Executive Function is a complex construct, generally dened as higher order cognitive abilities that facilitate strategic planning, cognitive exibility, goal-directed behavior and self-regulation (Weyandt, 2005), theoretically associated to the development of ADHD phenomena (Barkley, 1997). Emotional regulation, as a function mediated by higher order pre-frontal structures (Ochsner & Gross, 2008), has been linked to development and maintenance of internalizing and externalizing behavioral symptoms (Krueger, 2005). This study focuses on emotional regulation as it manifests in the expression of anger, and reactive inhibition, expressed in its polar opposite, sensation seeking (Blaskey et al., 2008). Method: 300 Puerto Rican adults complete the Wender Utah Rating Scale (WURS), the Emotions Scale (EE) and the Sensation Seeking Scale (EBS). The WURS is a 25-item self-report scale measuring ADHD-relevant childhood behaviors and symptoms in adults. The EE is a 64-item scale that assesses the expression of anger and hostility. It has 8 subscales and considers affective, cognitive and behavioral aspects of anger, including dimensions such as

P-14-11 Neurocognitive deciencies in adult ADHD; cognitive functions as marker and core decit O. Pazvantoglu*, A. Aker Alptekin, K. Karabekiroglu, G. Sarisoy, S. Akbas, S. Baykal, I. Zabun Korkmaz, E. Alkan Pazvantoglu, O. Boke, A. Rifat Sahin * Samsun, Turkey Objective: This study had three aims. First, we aimed to investigate cognitive decits in aADHD and to determine neuropsychological test that might be helpful to reveal these impairments in a more reliable manner, second, we intended to determine a neuropsychological marker for aADHD, and thirdly we aimed to reveal the cognitive function differences between aADHD cases and subjects with childhood ADHD whose symptoms did not persist from childhood to adulthood.

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149 Method: Parents of children with ADHD (N=103) were included. The cognitive functions of these parents, divided into three groups on the basis of diagnostic status (non-ADHD, n=34; childhood ADHD, n=35; aADHD, n=34) and a healthy control (HC) group of 35 individuals, were evaluated with a series of neuropsychological tests (NPts) and psychometric instruments Results: The aADHD group exhibited a worse performance in the majority of NPts compared to the HC group. Compared to the other groups, mostly the aADHD group demonstrated statistically signicant differences in terms of cognitive functions, while the Stroop test 5th sub-test (ST 5) and Part B of the Trail Making Test (TMT-B) were found to be associated with genetic loading (having a child with ADHD). In contrast to all the other measurements, only the ST 5 scores were associated with persistence of ADHD in adulthood. Conclusion: Results indicate that aADHD patients have decits in cognitive functions in terms of attention, vigilance, interference control and set-shifting, and these differential dysfuntions may be revealed by more complex NPts in particular. The decits with regard to interference control and set-shifting processes may be assumed as a neuropsychological marker for aADHD. Interference control-associated functional decit may be a core decit for ADHD that indicates a vulnerability factor. anxiety measures. The relationship between changes in self-reported symptoms of ADHD and anxiety will also be presented. Conclusion: Preliminary data suggests that ATMX is effective in modifying core ADHD symptoms compared to placebo, but had no effect on subjectively-rated anxiety. Future analyses will incorporate the objective IntegNeuroTM data.

P-15-02 Attention Decit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD): A case series demonstrating improved outcome when comorbid ADHD is treated with long-acting stimulant medication (LAS) G. Farrelly*, M. Zwiers * Calgary, Canada Objective: To demonstrate that optimization of ADHD treatment in the target population (ASD with ADHD) improves core ADHD symptoms as well as overall functioning, quality of life, social interaction, communication, and ability to manage environmental challenges. Method: 32 individuals, aged 4-18 years with Low Average to Very Superior IQ and meeting DSM-IV criteria for ADHD and ASD [Aspergers Syndrome (AS) and High Functioning Autism (HFA)] were assessed and followed through two multidisciplinary clinics from 1994 to 2011.Compared with other ADHD populations, this subset of individuals (ADHD ? ASD) appeared signicantly more sensitive to rapid on/off effects when treated with short-acting stimulants (SAS) prior to the introduction of LAS to the Canadian market in 2003. Even when core ADHD symptoms improved with treatment, the short duration of action intensied anxiety, irritability, agitation and temper. After 2003, all subjects were switched to or started on LAS and titrated slowly to optimized medication and dosage. Results: Improved quality of focus and impulse control were achieved by optimizing ADHD treatment with LAS. Subjects appeared to be less overwhelmed and more aware of their environment and social requirements. In turn, this enhanced their ability to use strategies to improve social skills, communication, and overall quality of life. Conclusion: Effectiveness and tolerability results differed from earlier research, possibly explained by variances in: population (higher IQ and more subjects with AS and HFA); use of LAS (both dextroamphetamines and methylphenidate) vs. SAS only; and individualized optimization of medication and dosage vs. forceddosage trials. Signicantly, few studies of stimulant treatment with PDD subjects have considered benets beyond the effective management of core ADHD symptoms. The current case series suggests that LAS may avoid polypharmacy, treat core symptoms of ADHD, and improve quality of life (social-emotional benets) in ASD populations.

Friday, 27 May 2011, 14.3016.00 P-15 Pharmacological treatment: Children and adolescents I
P-15-01 Examining the efcacy of atomoxetine on measures of cognition, emotional function and anxiety in children and adolescents with ADHD The ACTION study M. Kohn*, T. W. Tsang, D. F. Hermens, S. D. Clarke, C. R. Clark, C. Lamb, D. Efron, N. Cranswick, L. M. Williams * Westmead, Australia Objective: The ACTION study (Attention Decit Hyperactivity Disorder Controlled Trial Investigation of a Non-stimulant) was a multicentre, double blind randomised cross-over trial of a non-stimulant medication, Atomoxetine (ATMX), in children and adolescents with Attention Decit Hyperactivity Disorder (ADHD) [1]. The primary aim of this study was to examine the efcacy of ATMX for improving cognition and emotional function in ADHD, dichotomised by the presence or absence of anxiety. Method: A clinic population of 6 to 17 year-old boys and girls with a primary diagnosis of ADHD were randomised to receive either placebo or ATMX over a six-week period, followed by a washout period of one week, before cross over for the next six weeks. Testing occurred at baseline and at the end of each six week period on measures of anxiety and ADHD symptoms. Presence of comorbid anxiety was determined using the ADISC, and the mean dose of ATMX received was 1.2 mg/kg, once daily. A standardised battery was used, including objective psychometric measures for cognition and emotional function (IntegNeuroTM), and self report measures rating anxiety (CPRS-L, DASS and STAI-C) and ADHD symptoms (ADHD-RS IV and CPRS-L). Results: Of the 102 participants (81.4% male) who completed the study 26.5% had comorbid anxiety. Core ADHD symptoms of inattention, hyperactivity and impulsiveness were all reduced with treatment of ATMX compared to placebo (p\0.05). Preliminary analysis revealed a statistically signicant reduction in the CPRS: Anxious-shy t score (p=0.043) in participants with comorbid anxiety, but not in any other

P-15-03 Aripiprazole in children and adolescents with conduct disorder: A single-center, open-label study E. S. Ercan*, T. Uysal, E. Ercan, U. Akyol Ardic * Izmir, Turkey Objective: The aim of this study was to determine the effectiveness and safety of aripiprazole in children and adolescents with both Attention Decit Hyperactivity Disorder (ADHD) and conduct disorder (CD). Method: Twenty children and adolescents, ranging in age from 6-16 years, participated in a single-center, open-label study (19 to com-

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150 pletion). Children and adolescents were eligible for this study if they met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria for ADHD comorbid with severe CD. We began treating patients with 2.5 mg of aripiprazole in an open-label fashion for 8 weeks. Outcome measures included the Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV), the Clinical Global Impression Scale (CGI), the Child Behavior Checklist (CBCL), the Teachers Report Form (TRF) and the Extrapyramidal Symptom Rating Scale (ESRS), along with laboratory assessments. Results: The mean daily dosage of aripiprazole at the end of 8 weeks was 8.55 mg (SD=1.73), with a maximum dosage of 10 mg. Based on the global improvement subscale of the CGI, we classied 12 of 19 patients (63.1%) as responders (very much or much improved). We observed signicant improvements after aripiprazole treatment with regard to inattention, hyperactivity/impulsivity, ODD, and CD subscales of the T-DSM-IV (parent, teacher and clinician forms). We also observed signicant improvements on many of the CBCL and TRF subscales (e.g., attention problems as well as delinquent and aggressive behavior). The participants tolerated aripiprazole, and no patient was excluded from the study because of adverse drug events. Conclusion: Aripiprazole is an effective and well-tolerated treatment for ADHD and CD symptoms; however, additional studies (specically, placebo-controlled and double-blind studies) are needed to better dene the clinical use of aripiprazole in children and adolescents with ADHD-CD. P-15-05 Methylphenidate-induced changes of cerebral frontal inhibitory functions in patients with Attention Decit Hyperactivity Disorder T. H. Kim*, D.-H. Song, S.-J. KIm * Seoul, Republic of Korea Objective: We showed the result of the Methylphenidate (MPH)induced changes of cerebral frontal inhibitory functions in patients with Attention Decit Hyperactivity Disorder(ADHD). Previous studies reported that ADHD resulted from the decit of selective attention and sustained attention. But recent studies showed that the executive function problems decreased cerebral frontal inhibitory function in ADHD. Method: 16 patients with ADHD from outpatient clinic were recruited. After pharmacotherapy with methylphenidate for 12 weeks, We examined result of ADHD Diagnostic System (ADS) and the Stroop Test. Results: The study group showed improvement in the both test signicantly. In ADS test, in visual task there was decrease of the omission error rate and in auditory task there was decrease of both the positive responding time and the standard deviation of the positive responding time signicantly. In the Stroop Test, there was a decrease in the word task, the color task and the color-word task signicantly. Conclusion: Our result suggest that the range in the clinical improvement of ADHD symptom corresponds with the result of the cerebral frontal inhibitory functions test instead of attentions test. This result implies that we should be more interested in the improvement of executive function than attention decit clinically.

P-15-04 Does medication alleviate executive working memory decits in children with ADHD? T. Schleepen*, L. Jonkman * Maastricht, The Netherlands Objective: Prior research has established working memory (WM) decits in children with ADHD, especially in tasks that pose high demands on executive control controlled by brain networks involving the Prefrontal Cortex. It is however not clear to what extent children with ADHD still suffer from such executive WM-decits when taking their regular medication. The current study addressed this issue. Method: 29 ADHD children receiving their regular medication (ritalin and concerta) and 36 age-matched typically developing (TD) controls performed a verbal N-back task including 0-, 1- and 2-back conditions that differ in executive control demands. While the 0-back task does not involve any WM processes, the 1-back task involves the maintenance of only one letter in WM. Executive control is in particular required in the 2-back task, since besides simple maintenance, also the executive processes of updating and interference control are needed. By comparing performance between 0-vs. 1- and 1-vs. 2-back conditions, the process of maintenance and maintenance during executive control can be parcelled out, respectively. 2 9 2 ANOVA analyses were performed to examine group x condition differences. Results: Accuracy decreased from the 0 to 1-back and from the 1 to 2-back task in all subjects, but accuracy decreases were similar in both groups. Memory response decision time did also increase from 0- to 1 back and from 1-2 back in both groups, but ADHD children needed signicantly (and considerably) more time to reach a memory decision in the 2-back task that demanded high levels of executive control than TD children. Conclusion: The above results show that ADHD children who are on their regular medication still experience decits in verbal WM when high demands are placed on executive control. These decits manifest themselves in the form of more time that is needed to update information and ignore irrelevant items while maintaining information online.

P-15-06 Twelve-week administration of long-acting methylphenidate increases NAA/Cr and decreases Glu/Cr and Cho/Cr in the bilateral prefrontal cortices of schoolage children in Indonesia: study using 1H Magnetic Resonance Spectroscopy (MRS) T. Wiguna* * Jakarta, Indonesia Objective: This study is aimed to analyze the effect of 12 weeks administration of long-acting methylphenidate 20 mg toward the neurometabolites in prefrontal cortex in ADHD children by using 1H magnetic resonance spectroscopy. Method: This was a prospective study with one group using pretest and posttest design to evaluate the response of DA neurotransmission to long-acting methylphenidate 20 mg. We examined 21 ADHD children without any co-morbidity age 7 to 10 year old who were drug nave. A low Time Echo (TE) MRS scans sampled voxels of interest (1.5 9 1.5 9 2.0) both from the right and left prefrontal cortex in all subjects. Compounds which can be visualized with MRS included N-acetylaspartate (NAA), glutamate/glutamine (Glu), creatine/phosphocreatine (Cr), cholin (Cho) and myo-Inositol (mI). A pair t-test was used to analyze the mean difference of NAA/Cr, Glu/Cr, Cho/Cr and mI/Cr ratios. A standardized mean effect size (d) is also calculated by using the effect size calculator. Results: There was signicantly decreased of Glu/Cr, Cho/Cr ratio both in the right and left prefrontal cortex (p\0.05) after the subjects took 20 mg long-acting methylphenidate for 12 weeks. In this nding, NAA/Cr ratio increased signicantly (p\0.05) as well. All standardized mean effect sizes ranged from 0.541.17. Conclusion: these ndings suggested that administering long-acting methylphenidate 20 mg for 12 weeks is associated with enhancement of dopaminergic neurotransmission in prefrontal cortex areas.

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151 P-15-07 Five year follow up of psychosocial, sexual and academic outcome in children with Attention Decit Hyperactivity Disorder (ADHD) under treatment R. Sagar*, K. Sinha Deb, M. Mehta * New Delhi, India Objective: To study the long term outcome of treatment in children diagnosed with ADHD in the areas of severity of ADHD, psychosocial and sexual Adjustment and educational achievement. Method: The study was a naturalistic, descriptive follow-up study carried at the Child Psychiatry Clinic OPD, at the All India Institute of Medical Sciences, New Delhi, India. The study sample included 10 children with a clinical diagnosis of ADHD coming for regular follow up to the clinic for the past 5 years. All subjects were assessed clinically (as routine clinic protocol) to ascertain the diagnosis of ADHD. After diagnosis all patients were started on treatment as usual including medications for ADHD and counseling of family members by the clinical staff. Subsequently, severity of ADHD was assessed by Conners Parent Rating Scale. Psychosocial functioning was assessed by Strength and Difculty questionnaire (SDQ) and Childrens Global Assessment Scale (CGAS). Academic performance was assessed by Result of last school test. Descriptive statistics were used to nd major problem areas in various phases of treatment and age of patient. Results: The data was collected between 2005 and 2011. The sample was predominantly male (90%), with a mean age of 8.24 years at intake, and a mean age of 13.24 years at present time. Review of the 10 cases revealed that hyperactivity got controlled within months of initiation of therapy. Inattention was more difcult to control in the initial years. Conduct traits were most difcult to control and often required additional medications. Signicant improvement in academic performance was seen within the rst year of institution of treatment. Discontinuation of treatment happened at least once during the rst year in majority of the cases. However, compliance improved in all cases with time. New problems came to focus in later years, including the management of loss of appetite, decrease in body weight, difculty in interaction with peers and members of opposite gender adolescent sexual issues and substance abuse (in one case). Routine counseling of family members were instrumental in helping them to understand the problems and maintain compliance. Conclusion: The study highlights the various problems faced by patients of ADHD that are beyond the hyperactivity, inattention and conduct spectrum during a 5 year follow up of the cases. They are causes of concern for the parents and are important for the overall improvement of the patient and can be tackled easily by simple counseling. clinically to ascertain the diagnosis. Severity of ADHD was assessed by Conners Parent Rating Scale. Psychosocial functioning was assessed by Strength and Difculty questionnaire (SDQ) and Childrens Global Assessment Scale (CGAS). Academic performance was assessed by Review of Teachers Observation Report (TOR) and Result of last school test. After initial assessment all patients were started on treatment as usual and subjects were reassessed at 6 months using same measures. Informed consent and ethical clearance was taken. Statistical analysis was done by the SPSS (Version 10) software package. Comparison between baseline and follow-up measures were done by Paired t-test and Wilcoxon signed-rank test. Results: Of the 41 patients recruited in the rst visit 32 patients came for follow-up at six months resulting in 9 drop outs. The sample was predominantly male (92.68%), with a mean age of 10.04 years, belonging to nuclear family (75.61%) and predominantly of the ADHD HI (Hyperactive-Impulsive) subtype (51.22%). Comparison between baseline and follow up data revealed signicant reductions in severity in CPRS scores in all categories except in patients who were non-compliant to drugs and in patients with co-morbid disorders. The SDQ revealed signicant reduction in total difculty score (TDS) and conduct problem sub-scale (CPS), Peer relationship problem score (PPS) but no change in Emotional Symptom Sub-scale (ESS). There was signicant increase in CGAS scores at follow up. Results were most signicant in the drug compliant patients while age, sex, family type, family income, birth order, number of siblings, diagnostic subtype and IQ were not related to the outcome. Conclusion: Signicant improvement in severity of ADHD and academic and psychosocial functioning is possible in ADHD. Maintaining of therapeutic contact and compliance to medication are the most important parameters in improving the outcome in naturalistic settings.

P-15-09 Evaluation of cardiovascular effects of atomoxetine treatment upon children with Attention Decit Hyperactivity Disorder C. Gokcen*, A. Sert, E. Aypar, D. Odabas * Gaziantep, Turkey Objective: Atomoxetine is a central norepinephrine reuptake inhibitor used to treat Attention Decit Hyperactivity Disorder (ADHD). There are a few reports in literature upon the cardiovascular effects of atomoxetine therapy in children. The aim of this study was to determine whether atomoxetine treatment for 5 weeks is effective in changing mean heart rate, mean systolic and diastolic blood pressure (BP), QTc and left ventricular systolic functions in children with ADHD. Method: Fourty children with ADHD (6 females, 34 males) were included this study. Treatment was initiated at a standard specied dose (0.5 mg/kg/day) for all patients and increased to 1.2 mg/kg/day respectively based on parent and clinicians report at the rst week. Mean systolic BP and diastolic BP, heart rate, QTc, left ventricular systolic functions before and 5 weeks after atomoxetine treatment were recorded. Results: Atomoxetine decreased baseline mean systolic BP (from 94,88,5 to 93,512,3 mmHg, p=0,486) and baseline mean diastolic BP (from 61,210,1 to 60,77,3 mmHg, p=0,802); baseline mean heart rate slowed (from 88,317,5 to 85,415,3 beats/min, p=0,097); baseline mean QTc mildly increased (from 39124 to 39626 ms, p=0,245). Atomoxetine decreased baseline mean ejection fraction (from 71,15,1% to 69,14,7%, p=0,084) and baseline mean shortening fraction (from 39,84,3% to 38,1 3,7%, p=0,098) but there was statistically no signicant difference in terms of mean heart rate, mean systolic and diastolic BP, QTc and left ventricular systolic functions 4 weeks after atomoxetine treatment. Conclusion: Data suggest that atomoxetine do not cause statistically or clinically signicant alterations in systolic BP and diastolic BP,

P-15-08 Effectiveness of treatment on psychosocial adjustment and academic outcome in children with Attention Decit Hyperactivity Disorder (ADHD): A six month follow-up study K. Sinha Deb*, R. Sagar, A. Mittal, M. Mehta * New Delhi, India Objective: To study the short term outcome of initiating treatment in children diagnosed with ADHD in the areas of 1. Severity of ADHD. 2. Psychosocial Adjustment. 3. Educational achievement. Method: The study was a prospective, six month follow-up study carried at the Child Psychiatry Clinic OPD, at the All India Institute of Medical Sciences, New Delhi, India. The study sample included 32 newly registered children with a diagnosis of ADHD as per DSM-IV(TR) meeting inclusion criteria. Children with mental retardation (IQ\70), serious medical co-morbidity and children whose parents were unable or unwilling to provide information from the teachers were excluded. At intake all subjects were assessed

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152 heart rate, QTc and left ventricular systolic functions during shortterm treatment in children with ADHD. Cardiovascular effects of atomoxetine were minimal, and atomoxetine was well tolerated in short term study. However, double-blind, randomized, placebo-controlled studies are needed to conrm this. Method: Change in ADHD symptoms, as rated by parents and teachers on the German ADHD Symptom Checklist (FBB-ADHD), was examined post hoc in patients who had measurements at all 3 study visits (baseline, 13 weeks and 612 weeks after rst use of Equasym XL), using growth mixture modelling to detect trajectories. Sex, age, methylphenidate dosage before switch to Equasym XL, conduct problems, emotional symptoms and quality of life were considered as predictors of trajectory groups. Model selection was based on a formal statistical criterion (Bayesian information criterion) and clinical considerations. Results: Models with up to 8 classes were computed for parent (n=699) and teacher (n=521) ratings. Under consideration of the covariates, a 4-class solution tted the data best for both informants. Of these 4 classes, 1 class had low ADHD symptoms in the beginning and a stable course over the entire study (low-stable); the other 3 had high ADHD symptoms at study start. Among these high-symptom classes, 1 showed a stable course (high-stable), 1 had a strong decrease immediately after medication switch (high-baseline response), and 1 had a strong decrease during Equasym XL treatment (high-intervention response). All covariates except sex were signicant in predicting trajectory classes. Conclusion: Different treatment-response trajectories can be detected and group membership can be predicted. These results help to inform practitioners which patients are most likely to benet from treatment with Equasym XL. Supported by Shire Development Inc.

P-15-10 Effects of w3 Long-Chain Polyunsaturated Fatty Acids (LCPUFA) supplementation on information processing of ADHD children medicated with Methylphenidate D. Isenberg Bechar*, R. Geva, E. Granot, D. Margalit * Ramat-Gan, Israel Objective: Recent data suggest that impairments in information processing are central to ADHD (Mulder et al., 2010; Sohn et al., 2010). Increasing evidence suggests a positive association between FA and cognitive performance, including speed of information processing (Groot et al., 2007). The present study is part of a larger study aimed to investigate effects of combined treatment of MPH with x-3 LCPUFA on ADHD long term medicated children on various cognitive measures. Here we report on preliminary results of information processing speed. We hypothesized that x-3 supplementation will improve information processing through heightened alertness and inhibition. Method: 14 children (8 trial; 6 placebo, mean age 11.1 SD 2.3) were given 2 daily capsules containing 500/100 mg./d EPA/DHA ratio each, or placebo. Fatty acids were analyzed in serum phospholipids and red blood cell membranes at baseline and endpoint with gas chromatography. The study measured information processing speed and efciency as a function of three independent factors: commission errors and reaction time on the go/no-go task and word and color reaction time on the verbal interference task. Measures were the assessed using a touch-screen computerized battery (IntegNeuroTM). Results: ANOVA with repeated measures showed a signicant reduction (F=5.69; df=[12,1];p\0.05) in the go/no-go reaction time measure, but not on accuracy, since there were no reductions in Commission errors, in the LCPUFA trial group, compared with control. A reduction in the commission errors was also found, although not signicant. Changes in verbal interference were not signicant, but a greater reduction in the color, compared with the word reaction time, was found in the trial group. Conclusion: data partially support the potential role of x-3 LCPUFA in the regulation of information processing. These improvements may be related with Executive efciency. Further exploration of added LCPUFA to MPH intervention is encouraged.

Friday, 27 May 2011, 14.3016.00 P-16 Pharmacological treatment: Children and adolescents II
P-16-01 A single-center, single-blind, randomized, oral dose crossover study in prepuberal boys with ADHD to investigate efcacy and bioequivalence of two modied release Methylphenidate formulations C. Fleischhaker*, K. Hennighausen, K. Schneider-Momm, E. Schulz * Freiburg, Germany Objective: The primary objective of the study was to determine Pharmacokinetics (PK) and bioequivalence of 20 mg Ritalin LA compared to 20 mg Medikinet retard. Method: 24 prepubertal boys aged 8 - 14 years with ADHD were enrolled. Cohorts of 6 subjects each were assessed on two 9-hour classroom setting. Serum MPH concentrations, ratings of classroom behavior on the SKAMP were measured repeatedly. Results: Among the patients, the complete determination of the pharmacokinetic parameters could be performed for 20 patients. Equivalence could not be concluded for Cmax serum MPH concentration at a 5% signicance level. In approx. 50% of patients, MPH concentrations have formed two distinctive peak levels. In a crossover analysis, the SKAMP Scales showed no signicant treatment effects. Regarding the subjects condition in the week prior to the visits, however, there was a signicant positive effect in favorite of Ritalin LA as assessed by the primary caregiver. For both medications, no serious adverse events could be observed. Conclusion: An analogue classroom setting provides a reliable parallel assessment of behavioral and PK data. PK data showed remarkable inter-individual variations. In both medication groups, the pharmacokinetic proles have revealed two distinctive peak levels in more than 50% of patients.

P-15-12 Treatment response heterogeneity in children with ADHD during treatment with modied-release methylphenidate in the observational OBSEER study M. Dopfner*, C. Hautmann, A. Rothenberger * Koln, Germany Objective: OBSEER was a prospective, observational study examining effectiveness and safety outcomes over 3 months in patients (aged 617 years) with Attention Decit Hyperactivity Disorder (ADHD) receiving once-daily modied-release methylphenidate (Equasym XL) under routine care. Children with ADHD vary in their response to drug treatment and follow different trajectories of symptom severity over time. This analysis investigated predictors for different treatment-response trajectories.

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153 P-16-02 Side effects in adhd patients treated with methilphenidate: A comparison between different formulations M. Pinto*, C. Cordovil, C. Amado * Barcarena, Portugal Objective: Methylphenidate (MPH) is the most widely used stimulant medication in the treatment of Attention Decit Hyperactivity Disorder (ADHD). In our country it is available in short- (2-4h) (SF), intermediate- (6-8) (IF) and long-acting (10-12h) (LF) formulations. Choice is usually made individually but side effects often lead to treatment changes. The aim of our study was to evaluate side effects in ADHD patients treated with different formulations to see if adverse effects were depending on formulation type or on total daily dose. Method: Adverse effects questionnaires were given to parents of ADHD patients on MPH treatment in our clinic. Patients were distributed according to the formulation type they were receiving into SF, IF or LF groups. Sex, age, weight and total daily dose were also registered. Statistical analysis was performed stratied by formulation type, gender and total daily dose/weight. To evaluate the association between side effects and formulation type we used Pearsons Chi-squared test with simulated p-value and Goodman & Kruskals lambda. Results: A total of 155 questionnaires were received (104 males; 51 females), 37 in the SF, 86 in the IF and 32 the LF groups. Median age was 9, 10 and 13 years, respectively. Most frequent side effects reported were poor appetite (p-value = 0.1) and sleeping problems (pvalue = 0.2). However none of the side effects showed to be strongly dependent of formulation group and side effects presence and intensity were not dosage/weight dependent. Conclusion: Side effects are rarely reported by parents of ADHD patients receiving MPH, being most frequently poor appetite and sleeping problems. There seems to be individual variability and not dependence on formulation type or on total dosage, so treatment must be tailored to each patient based on other factors. However side effects still need to be monitored and formulation changed when they occur. addition, parents demonstrated an association between anxiety comorbid disorders and a better response to a high dose of methylphenidate. Conclusion: This study suggests that a strong reactivity of the HPA axis improves the clinical response at high dose, but that chronically elevated cortisol might be a marker for nonresponders. The results of this study should be seen as preliminary and require further testing of the possible interactions between ADHD medication and HPA activity.

P-16-04 Methylphenidate effect on neuro-cognitive test battery E. S. Ercan*, E. Ercan, F. S. Durak * Izmir, Turkey Objective: The aim of this study was to assess the effectiveness of methylphenidate treatment for ADHD cases by using neuro-cognitive test battery (CNSVS Test Battery) and nd out differences between ADHD combined type and ADHD attention deciency subtypes. Method: Sample of the study included 198 children and adolescent aged between 8- 18 years (156 boys, 42 girls; mean of age, 11.422.47) who met the DSM-IV diagnosis of ADHD based on the assessment Schedule for Affective Disorders and Schizophrenia for School-Aged ChildrenEpidemiologic (Version 1; K-SADS-PL). Eighty two cases were diagnosed as ADHD attention deciency subtype and 116 cases were diagnosed as ADHD combined subtype. The sample group was evaluated with CNSVS Test Battery which is a computerized assessment including verbal memory test, visual memory test, nger tapping test, symbol digit coding, stroop test, shifting attention test and continuous performance test and is sensitive to assess performance of children and adolescence with ADHD (Gualtieri & Johnson, 2006). Improvement of the cases on the neurocognitive tests was evaluated before and after the methylphenidate treatment. In addition, clinical improvements of the sample group were compared with DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale for parents and clinical global (CGI) improvement impression subscale. Results: Before and after methylphenidate administration, neurocognitive performance as measured by CNS Vital Sign Battery showed signicant improvement between pre-and post test administration (p\.001) except memory test. Conclusion: According to this, methylphenidate treatment signicantly improved neuro-cognitive performance of Turkish sample. Resuls also revealed that ADHD combined and attention deciency subtypes were almost equally improved on CNSVS Test Battery except memory subtest.

P-16-03 Effect of increasing doses of methylphenidate as a function of free salivary cortisol and comorbid anxiety in children with ADHD P. Robaey*, R. Menneh, P. Hastings, I. Fortier, L. Simard * Ottawa, Canada Objective: The most prescribed medication for ADHD is methylphenidate, a psychostimulant that blocks the dopamine transporter and increases dopamine availability in the synaptic cleft. Preclinical and clinical studies show that cortisol may enhance dopamine effects. Dysregulation of the hypothalamic-pituitary-adrenal axis is also associated with many psychiatric disorders such as depression, bipolar disease, and anxiety. We hypothesized that cortisol has an inuence on the efcacy of the treatment of ADHD symptoms with methylphenidate. Method: The objective of this study was to measure the salivary level of cortisol in a sample of 8-year-old children with ADHD upon waking and in response to a venipuncture. The children were then randomized to three doses of methylphenidate and a placebo in a double-blind cross-over design. Teachers and parents rated the behaviour of the children using the SWAN and a side effect rating scale. Results: The results showed that high morning cortisol is a good predictor of a nonresponder under active medication, as reported by parents. Also, the high cortisol stress reactivity group, but not the low cortisol stress reactivity group, demonstrated a greater benet going to a higher dose of methylphenidate, according to teachers. In

P-16-05 Possible interaction effect of dopaminergic and noradrenergic gene polymorphisms on methylphenidate response in a Korean ADHD sample S. B. Hong*, H.-J. Yoo, B.-N. Kim, M.-S. Shin, S.-C. Cho, J.-W. Kim * Seoul, Republic of Korea Objective: Leading candidate genes of Attention Decit Hyperactivity Disorder (ADHD) include those involved in dopaminergic or noradrenergic neurotransmission, and these genes have also been implicated in the response to ADHD medication. We aimed to investigate the independent and interaction effects of selected polymorphisms at four major candidate genes for ADHD, namely dopamine transporter gene (DAT1), dopamine D4 receptor gene (DRD4), adrenergic alpha-2A receptor gene (ADRA2A), and

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154 norepinephrine transporter gene (SLC6A2), with regard to treatment response to methylphenidate (MPH). Method: The participants of the study were children and adolescents diagnosed as having ADHD according to the DSM-IV criteria. They were enrolled in an 8-week, open-label trial of MPH. The good responder group was dened as subjects having a 50% or greater decrease in the ADHD Rating Scale-IV (ADHD-RS) total score from the baseline, and at the same time a Clinical Global ImpressionImprovement Scale (CGI-I) score of 1 or 2, both at the 8th week of MPH treatment. Multivariate logistic regression was performed to examine the independent and interaction effects of genotypes on the dichotomized MPH treatment response. The statistical model included terms for each genetic polymorphism and at the same time terms for each pairwise interaction of these polymorphisms; then stepwise variable selection procedure using backward elimination (Wald) was employed, with a signicance level for removal from the model set as 0.10. Results: Signicant interaction effects on MPH response were detected between the genotypes of the DRD4 VNTR polymorphisms and those of either the ADRA2A DraI or the SLC6A2 -3081(A/T) polymorphisms; signicant interaction effects were also detected between the genotypes of the ADRA2A DraI polymorphisms and those of either the SLC6A2 G1287A or the SLC6A2 -3081(A/T) polymorphisms. No signicant independent effect of a certain genotype was detected according to the stepwise logistic regression results (Table 3, Figure 1). Conclusion: We have selected the two most promising polymorphisms from each of the two major neurotransmitter systems implicated in MPH response, the dopaminergic and noradrenergic systems, and the consequent results support that genes involved in these two systems might interact to form important predictors of short-term response to MPH. The combined response criterion of the parent-rated ADHD-RS scores and the clinician-rated CGI-I scores might have improved the reliability of our data. Nonetheless, more objective outcome measurements, preferably involving endophenotypes of ADHD, are recommended for future studies. haplotype showed much better improvement than those with 3GT and 4TC haplotypes (ADHD-RS total and subscale score changes: MANOVA, F = 2.234, p = 0.043, with moderate effect size: r = 0.40*0.60). In the second sample using OROS MPH, four out of ve polymorphisms were nd associated with ADHD-RS score change (rs5905859, rs2239448, rs3027400, rs1137070), especially parentrated attention subscale score change (P \ 0.05). Conclusion: Both studies in two independent samples suggest association between MAOA polymorphisms and the improvement of ADHD symptoms with MPH treatment.

P-16-07 Pharmacotherapy of Attention Decit Hyperactivity Disorder in children with epilepsy A. Kesic*, A. Lakic, V. Milovanovic, P. Ignjatovic * Belgrade, Serbia Objective: The aim of this study was to evaluate clinical results, side effects and seizure control in children with ADHD and epilepsy, which are treated with OROS methylphenidate. Population studies suggest that the prevalence of ADHD in childhood epilepsy is betweene 12 and 17%.The treatment of ADHD in children with epilepsy, can become a challenge for doctors who are forced to prescribe drug combinations. Method: We have analyzed a group of fteen children with Attention Decit Hyperactivity Disorder and epilepsy (10 males and ve females), of the age between seven and fteen years. They were seizure-free at least six months, before we started treatment with OROS-methylphenidate. We have evaluated the efcasy of MPH (18 and 36 mg/day) using SNAP-IV scale. Digitalized EEG were recording every three months.The follow-up period for at least one year was one of the inclusion criteria. Results: The therapeutic effect of drug was monitored by clinical observation and SNAP IV scale, over a year.OROS MPH signicantly improved ADHD symptoms by lowering score on SNAP IV scale.In our group of patients, OROS methyphenidate was well tolerated. Some side effects, such as decrease in appetite and sleep disturbance, were mild and transient, and it occurs in 4 children. No seizures were observed in our group during the one year study period.

P-16-06 Monoamine oxidase a gene is associated with methylphenidate response in ADHD children: Results in two independent samples L. Yang*, Y. Chen, L. Liu, H. Zhang, Y. Wang * Beijing, Peoples Republic of China Objective: The efcacy of ADHD medications is suggested to be mediated by changes in dopaminergic and noradrenergic functioning. Monoamine oxidase A (MAOA) plays an important role in regulating catecholamine level in central nervous system. We hypothesized that allelic variation in MAOA contributes to inter-individual variation in clinical response to methylphenidate. Method: We studied the association between MAOA and methylphenidate response in two independent samples. (1) Ninety Han Chinese boys meeting DSM-IV criteria for ADHD were recruited. Immediate released methylphenidate treatment was given in titrated doses in order to achieve optimal response. Behavior changes were measured using the ADHD Rating Scale-(ADHD-RS) IV at baseline and after optimal doses were reached. The MAOA 30bp VNTR, T941G and C1460T polymorphisms were genotyped. (2) One hundred twelve ADHD boys were given Osmotic-Release Methylphenidate (OROS MPH) treatment. The dose was also titrated to optimal. The same behaviour rating scales were used to assess the response. Five polymorphisms were genotyped (rs5905859, rs2239448, rs3027400, rs1137070, rs3788862). Results: In the rst sample using immediate released methylphenidate, haplotype analysis revealed that some patients with the rare 3TC

P-16-08 Treatment adherence of osmotic release oral systemmethylphenidate in children and Adolescents with Attention Decit Hyperactivity Disorder H. Yoo*, B. Kim, A. Y. Son, C. Suh * Gui-Dong, Seoul, Republic of Korea Objective: The objective of this study was to evaluate the treatment duration and adherence of OROS methylphenidate for the treatment of ADHD. Method: 218 children with ADHD (10.52.73 years old) who had previously taken medications for ADHD and 632 drug naive children with ADHD (11.342.91 years old) were recruited. The dosage was adjusted according to the clinicians judgment. The SNAP-IV, CGI-S, CGI-I, and side effect rating scale were measured at every visit. Results: The medications which had been taken by the children were found to be ER-MPH, IR-MPH, and atomoxetine in order from most common to least common. The drug naive children were older, and more of them belonged to the inattentive subtype compared to those who had previously taken medications. The factors inuencing treatment adherence were other ADHD medications and change of the CGI. The presence of comorbidity was not signicant (p=0.058) but might have inuenced treatment adherence. Conclusion: In the current study, age, sex, family history of ADHD, subtypes of ADHD, pattern of treatment medications, and side effects

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155 of the medication did not show any statistically signicant relationship with treatment adherence. On the contrary, other ADHD medications and change of the CGI were associated with treatment adherence. The presence of comorbidity might inuence treatment adherence. P-16-11 Effects of methylphenidate treatment on ROS formation in the blood of children with ADHD P. Heiser*, O. Sommer, A. Hoinkes, M. Rottinger, U. Hopt, A. Schmidt, E. Schulz, K. Hennighausen, H.-W. Clement * Freiburg, Germany P-16-09 Alterations of oral language in the Attention Decit/ Hyperactivity Disorder and correlation with stimulant treatment M. Periotto*, E. Barbante Casella, S. Pacheco, S. Branco, U. Reed * Sao Paulo, Brazil Objective: We studied the oral narrative in a task of recounting of story and the evolution after treatment with methylphenidate. Method: We investigated 36 children (aged seven to 14 years), and 34 normal controls, during performance in the narrative evaluation of the speech oral in task of recounting of history, pre and after treatment with methylphenidate. The inclusion criteria were: IQ [85 in the WISC test and to study in regular school. The points evaluated were: oral narrative speech; narrative speech in a task of story recounting. Results: The ADHD group had a mean of 8.83 (33.96%) sentences remembered and the control group 12.62 (48.54%)(p = 0.001). The ADHD group had a mean total errors of 5.75 versus 3.32 in control group.(p = 0.001). Regarding the type of error, the difference was signicant only for error of misinterpretation (p \0.001) (ADHD group 1.53, control 0.44). The analysis after the treatment was done only in the group with ADHD and it was observed a signicant increase in the number of sentences retold for children (p = 0.001). At baseline, the average sentence was retold of 8.83 (SD = 4.67) and after the use of stimulant, the average was 13.44 recounted sentences (SD = 4.79).There was no signicant difference in the performance of children between the assessment and reassessment in the categories of errors (segmentation, misrepresentation, substitution, ambiguous reference, adding ctitious, repetition), as well as the frequency of these errors. Conclusion: Memory of history improved with the pharmacologic treatment. Did not occur a decrease in the frequency and in the types of errors and we believe that was by the fact that it was not done a specic speech therapy. Objective: There are some hints of an increased oxidative stress level in patients with ADHD (e.g. increased lipid peroxidation). Oxidative stress is a synonym for enhanced reactive oxygen species (ROS). Cellular oxidative stress indicators are leucocyte, especially macrophages, formed from precursor monocytes and pollmorphonuclear leucocytes (PMN). Aim of our study was to analyze the formation of ROS in the whole blood and in PMN leucocytes after methylphenidate (MPH) intake in ADHD patients. Method: Blood was analyzed in 12 drug-naiv ADHD patients and 9 ADHD patients treated with MPH (between 6 and 12 years old). The rst blood probe was taken before the attitude on the medication and the second after the attitude. Blood sampling started at 10 a.m. (2 h after MPH intake) followed by measuring the formation of ROS in the whole blood and in isolated PMN obtained after Ficoll density gradients centrifugation. ROS detection was carried out by electron spin resonance spectroscopy using the spin label CMH (1-hydroxy-3methoxycarbonyl-2,2,5,5-tetra methylpyrrolidine). The responsiveness of ROS formation in PMN leucocyte was analyzed by stimulation with phorbol12-myristate13-acetate and inhibited by CuZn superoxide dismutase. Also the MPH concentration of the patients was measured in the serum. Results: The mean MPH concentration was 0.96 mg/kg. ROS formation in whole blood decreased signicantly from 108 3 nmoles O2/ml/min in the drug-naiv patients to 76 3 nmoles O2/ml/min in MPH-treated patients. The same decrease of ROS formation was observed in PMN leucocytes (drug-naiv patients: 33 6 nmoles O2/ min/106 cells, MPH-treated patients: 143 nmoles O2/min/106 cells). Conclusion: MPH reduces oxidative stress by a diminished formation of ROS in ADHD patients. This could be a reason why MPH may not lead to cell damage and is supporting the clinical observations that MPH is usually well tolerated.

P-16-10 A re-examination of acute tolerance, Tachyphylaxis and Hysteresis Loop in the Pharmacokinetics and Pharmacodynamics of immediate release methylphenidate in individuals with ADHD D. Quinn*, M. Denis, M. Cavanagh * Saskatoon, Canada Objective: To discuss the terms: Acute Tolerance, Hysteresis Loop and Tachyphylaxis. Acute Tolerance, Tachyphylaxis are frequently used to describe the rapid decrease in clinical response despite plasma levels being elevated. The term Hysteresis Loop is more appropriate. Method: 31 subjects (Children 7-12) were treated with either d-Methylphenidate (2.5 mg, 5 mg or 10 mg), dl-Methylphenidate (5, 10 or 20 mg) or placebo in crossover double blind clinical trial in an Analog Classroom Setting. Results: Data was collected over time measuring plasma level and using a clinical measure of response (PERMP). Data was analysed and graphed using a Bivariate correlation. Both compounds (d-Methlpenidate and dl-Methylphenidate were superior to placebo. Conclusion: Clinical response occurs faster than plasma levels and supports the concept of a Hystersis Loop.

P-16-12 Osmotic-controlled release oral delivery system Methylphenidate treatment reduces parental stress in children and adolescents with Attention Decit Hyperactivity Disorder in Korea H. Yoo*, J. M. Ahn, B. Kim, Y. J. Park * Gui-Dong, Seoul, Republic of Korea Objective: The purpose of this study was to investigate the parenting stress of parents of children and adolescents with Attention Decit Hyperactivity Disorder (ADHD) and to assess whether the parenting stress could be reduced by Osmotic-controlled Release Oral Delivery System (OROS) methylphenidate treatment. Method: 495 subjects (10.4 2.8 years of age, 391 (79%) males) with ADHD were recruited. Assessments including the Parenting Stress Index (PSI), ADHD Rating Scale (ARS) parent version, Beck Depression Inventory (BDI) for caretakers were conducted at baseline and after OROS methylphenidate for 8 weeks. Paired t-test and stepwise regression test were used to assess the effects of medication and the associated clinical factors on drug effects. Results: 342 (69.1%) subjects were combined type and 98 (19.8%) were predominantly inattentive type of ADHD. Signicant reduction was observed in the PSI scores between baseline and endpoint (P \ 0.001). The BDI and ARS changes were associated with the PSI

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156 changes between pre- and post-medication, accounting for 20.1% and 10.0%, respectively (p \ 0.001). Conclusion: To conclude, this study result suggests that parents of children and adolescents with ADHD have greater parenting stress. The increased parenting stress of caretakers of children and adolescents with ADHD can be reduced by short-term drug treatment of ADHD. In addition, the improvement of parenting stress of by medication may be associated with the reduction of ADHD symptoms and parental depressive mood. * Munchen, Germany Objective: Attention Decit Hyperactivity Disorder (ADHD) is a frequent psychiatric disease also in adults. Deriving measurable cognitive endophenotypes of the behavioral impairments with experimental neuro-cognitive assessment promises to improve diagnosis, evaluation of treatment response, and disentanglement of genetic and environmental inuences. In a prior study we found signicant working-memory (WM) storage capacity reductions in unmedicated ADHD patients compared to normal controls. Method: In order to systematically specify the effect of medication on attentional components in adults with ADHD, we used an assessment based on Bundesens theory of visual attention (TVA). In an exploratory study we compared a group of adult ADHD patients on ADHD-specic medication with an unmedicated patient group and a demographically matched healthy control group. The TVA-based assessment provides four quantitative, mathematically independent parameter estimates that are highly sensitive even for subtle attention decits: visual perceptual processing speed (elements/s), WM storage capacity (number of elements), spatial distribution of attentional weights, and top-down control. All parameters are assessed with highly similar stimuli (letters) and response requirements (verbal report), imposing comparable demands on perceptual and motor skills. Performance is assessed in terms of accuracy at certain exposure durations instead of response latency, avoiding confoundation with motor dysfunction (e.g. hyperactivity). Results: WM storage capacity was signicantly higher in medicated than in non-medicated patients, but still signicantly worse compared to normal controls. Mirroring previous results, medication did not affect perceptual processing speed, spatial weighting and top-down control. Conclusion: Medication seems to ameliorate the WM storage capacity decit in ADHD to a certain degree, but not to a normal degree. Since no decits in speed and top-down control have been found using the TVA based assessment, the ndings of slow and variable performance in response-based tasks might rather reect impairments in later, motor response stages than impairments in perceptual information processing.

Friday, 27 May 2011, 14.3016.00 P-17 Pharmacological treatment: Adults I

P-17-01 Usage trends of ADHD medication by bipolar patients with attentional decits I. Szpindel*, R. McIntyre * Toronto, Canada Objective: To observe ADHD medication usage trends in bipolars with attentional decits and identify patterns that might aid in diagnosis and improve management. Method: Patients referred for attentional assessment and diagnosed with bipolar disorder in the greater Toronto Area between 2008-present were observed naturalistically. The full spectrum of bipolar disorder was considered along with both stimulant and Nonstimulant class medications indicated for ADHD use in Canada. Results: Bipolar patients not stabilized pharmacologically experience acceleration of their cycles across classes with all medications, and more pronounced with the more noradrenergic agents. Patients with sufcient pharmacological stabilization did not accelerate or destabilize. Unstable patients frequently reported signicant response or intolerable side effects at relatively low doses of medication. Subjective attentional improvements reported by these patients did not correlate with clinical assessment, were short-lived and episodic, and required escalating doses and frequent switches of medication. Many unstable bipolars had already developed, or showed a preference for, patterns of brief episodic medication use coinciding with switches to manic or hypomanic phases. Conclusion: Insufciently controlled bipolars using ADHD medication across classes risk destabilization and acceleration of their progressively neurotoxic underlying disorder. The more noradrenergic the agents, the more obvious and early the reaction. Sufciently stabilized bipolars appear protected from this effect. A pattern of escalating episodic ADHD medication dosing adopted by uncontrolled bipolars seemed consistent with self induction of manic switching during episodes of depression. Reported initial sensitivity to unusually low doses of medication likely represents a similar triggering of manic switch which is misinterpreted by the patient as emotional and cognitive improvement. Awareness of these distinguishing characteristics and behaviours may aid in the earlier identication and differentiation of bipolar patients from those comorbid with, or incorrectly diagnosed as, ADHD.

P-17-03 Long acting Methylphenidate improves cortical dysinhibition in adults with ADHD: A study with paired pulse Transcranial Magnetic Stimulation M. Schneider*, W. Retz, G. Gougleris, W. Verhoeven, J. Tulen, M. Rosler * Venray, The Netherlands Objective: Systematic evaluation of the effects of long acting methylphenidate (LA-Mph) on motor cortex excitability in adult patients with ADHD with the paired pulse transcranial magnetic stimulation (ppTMS) technique. Method: Thirteen right handed drug nave adult ADHD patients were included in this ppTMS study. Measurements took place before and under treatment with 30-54mg LA-Mph (daily dose). Statistical analyses were performed to investigate treatment effects and correlations with clinical symptomatology. Results: LA-Mph signicantly decreased the relative short intracortical motor inhibition (SICI) magnetically evoked potential (MEP) amplitude at 3ms interstimulus interval (conditioned/unconditioned MEP amplitude: 0.840.76 drug-free vs. 0.290.19 with LA-Mph; p=0.020). The relative intracortical facilitation (ICF) MEP amplitude at 11ms interstimulus interval (conditioned/unconditioned MEP amplitude: 1.510.92 drug-free vs. 1.790.95 with LA-Mph) was not signicantly increased. The decrease of the relative SICI MEP

P-17-02 Systematic parametric assessment of attentional dysfunction in medicated adult patients with Attention Decit Hyperactivity Disorder W. Schwarzkopf*, K. Hennig-Fast, U. Muller, T. Frodl, H. Muller, R. Engel, M. Riedel, H.-J. Moller, K. Finke

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157 amplitude with LA-Mph correlated signicantly with the improvement of the psychopathological ADHD self-rating total scores (p=0.034) and hyperactivity/impulsivity subscores (p=0.029). These results show that in adult patients with ADHD, LA-Mph signicantly improves motor disinhibition, but has no signicant inuence on motor facilitation. Conclusion: LA-Mph might have differential stabilizing effects on motor hyperexcitability in adults with ADHD which correlates with the clinical improvements. These results are the basis for future pharmacological investigations of disturbed motor cortex excitability in adult ADHD. (PROs) when switched from a stable dose of Concerta (OROS-MPH) to the same dose of the generic Novo-Methylphenidate ER-C (MPHER-C) Method: A single centre, randomized double-blind cross-over trial was conducted in 20 adult patients with a primary diagnosis of ADHD. Patients were stable on OROS-MPH for at least 3 months before being randomized to receive either MPH-ER-C or OROSMPH in a two way cross-over design, after signing informed consent. Treatment periods were 3 weeks in duration at the patients current OROS-MPH dose, or mg-mg equivalent of MPH-ER-C. Patient-and physician-reported outcomes were assessed at baseline of each period and at the end of this study; analysis was conducted using a linear mixed effects ANOVA model. Results: Nineteen of the 20 enrolled patients were included in the efcacy analysis. The primary endpoint was, change over time in the Treatment Satisfaction Questionnaire for Medication- version II (TSQM-II) scores. Statistically signicant differences were observed between OROS-MPH and MPH-ER-C in the TSQM-II effectiveness (p=.04) and side effects (p=.03) subscales, which were also supported by changes in the Adult ADHD Quality-of-life Scale (AAQOL) and physician reported CGI-I and CGI-S. More adverse events were reported when treated with MPH-ER-C. Five patients withdrew upon switching to MPH-ER-C; one paitent withdrew consent. Conclusion: Patients treated with a stable dose of OROS-MPH were more satised in terms of efcay, side effects than those receiving an equivalent dose of the generic, MPH ER-C; this was also supported in the physician-reported CGI outcomes. All patients elected to return OROS-MPH at the conclusion of the trial. Although these treatments are deemed bioequivalent, this study shows clinically and statistically signicant differences in patient-and physician-reported treatment outcomes as well as patient discontinuation rates, which warrant further investigation.

P-17-04 Mood stabilization protocol mitigates risk in high-risk ADHD A. Ocana*, R. Rivers * West Vancouver, Canada Objective: Patients with ADHD can present with extreme academic, vocational and interpersonal impairment. The sum of which can be associated with enormous social costs. This is especially true among those with comorbid mood instability, such as Bipolar Spectrum Disorder; or comorbid disorders of reward regulation, such as substance use disorder or impulse control disorders. Thus a patient with ADHD and bipolar disorder, who has abused cocaine in the last year, would be conceptualized as ADHD plus Mood and Behavioural Instability (MBI). The object of this retrospective study was to review clinical outcomes in stimulant-treated patients with ADHD plus MBI or as we have termed it, high risk ADHD (HR-ADHD). Method: NorthShore ADHD clinic (northshoreadhd.com) is a tertiary referral centre. In reviewing our clinical registry, 816 patients met the DSM IV-TR criteria for adult ADHD. Of these, 576 had at least one comorbid diagnosis, and 360 had HR-ADHD. All patients received a mood stabilization protocol which included strength-based counselling as well as coaching on diet, exercise and stress resilience. HRADHD patients underwent further mood stabilization with Lamotrigine (36.9%), Divalproate (6.4%), Topiramate (3.3%) or Lithium (1%). Prior to receiving stimulant medication, patients had to have 3 months recovery, documented by urine drug screen. Clinical outcomes were rated using the CGI. Results: The HR-ADHD groups baseline Global Assessment of Function (GAF) was 85-15; mean = 49.7; SD = 15.06. The mood stabilization protocol was successful, showing better than expected outcomes in stimulant treated patients, even in the group that included patients who were homeless and/or actively abusing substances (GAF\50). Of these, 79.8% had a positive response: Full remission, CGI=1 (28.9%); Near remission, CGI=2 (28.9%); Response, CGI=3 (22%). Mood stabilizing medications had a relatively low rate of adverse events (n=7) and mild-moderate allergic reactions (n=9). Conclusion: Because of the frequency of negative outcomes, patients with high risk ADHD, i.e. ADHD associated with comorbid mood or behavioural instability, may not receive treatment. A mood stabilization protocol can mitigate a signicant portion of that risk.

P-17-06 Comparative effects of Methylphenidate and Atomoxetine on AQT processing speed in ADHD Adults: Preliminary ndings N. P. Nielsen*, E. H. Wiig * Kbenhavn, Denmark Objective: To evaluate effects of treatment of ADHD adults with methylphenidate and atomoxetine on A Quick Test of Cognitive Speed (AQT) processing speed and efciency. Method: We administered the color, form and color-form naming tests to 13 ADHD adults (ages 17 to 41) and compared measures (sec.) without medication and after treatment with methylphenidate and atomoxetine. At baseline, ASRS-V1.1 ratings ranged from 22 to 56 (M = 40.33), indicating likely ADHD. Results: There were signicant differences in cognitive speed (F2,36 = 26.31; p = .000000) and processing efciency (F2,36 = 10.50; p = 0.0002) between pre- and post-treatment measures. Pre-medication, cognitive-speed (color-form) and processing-efciency (cognitive overhead) (M = 73.69 and 17.34 s.) were signicantly slower/larger than post-treatment with methylphenidate (M = 53.69 and 8.08 s.) and atomoxetine (M = 48.46 and 3.56 s.). Cognitive-speed and processing-efciency did not differ signicantly after treatment with methylphenidate (M = 53.69 and 8.08 s.) and atomoxetine (M = 48.46 and 8.23 s.). After medication with atomoxetine, ASRS-V1.1 ratings ranged from 11 to 36 (M = 23.56). Conclusion: Within the limitations of this study, ndings suggest that methylphenidate and atomoxetine affect cognitive speed and processing efciency similarly.

P-17-05 A randomised, double-blind cross-over, single-centre study to evaluate patient and physician reported outcomes on Concerta-Oros-Methylphenidate vs. the Generic NovoMethylphenidate ER-C A. Fallu*, F. Daboux * Sherbrooke, Canada Objective: The objective of the study was to evaluate adult ADAH (Attention Decit Hyperactivity Disorder) patient reported outcomes

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158 P-17-07 The positive impact of methylphenidate in a sample of patients with Irritable Bowel Syndrome T. Freire Barbosa*, E. Barbante Casella * Sorocaba, Brazil Objective: Irritable Bowel Syndrome (IBS) is one of the most common gastrointestinal disorders in the general population, affecting people of all ages. It is a chronic functional disorder of the intestines and is characterized by abdominal pain or discomfort, atulence and bloating associated with altered bowel habits. There is no specic exam to diagnose IBS and there is no single treatment established. After observing that some patients with Attention Decit Hyperactivity Disorder (ADHD) that presented signals and symptoms of IBS, which improved with the pharmacologic treatment of ADHD, and considering the fact that the catecholamines associated to ADHD also have a role in the control of the intestinal motility, we decided to study the correlation of these two conditions. Objectives: to review the pathophysiology of IBS and discuss the possibility of a positive impact of methylphenidate in IBS. Method: We studied nine patients, aged 5 and 59 years. All the patients had the diagnosis of ADHD and presented clinical symptoms of IBS. It was used Methylphenidate (MPH), initially in the dose of 0,5 mg/kg/day, and it was been readjusted individually, having as objective, the improvement of the picture of the ADHD. Results: Improvement was observed in all patients, in the ADHD and IBS symptoms. Conclusion: Although the pathophysiology of IBS is unclear, adds observations about relationship with central nervous system (CNS) maybe considered. Many of the neurotransmitters that found in the CNS have also been identied in the enteric nervous system (ENS), such catecholamines which modulate gastrointestinal motility, also controls the functioning of related cerebral circuits to the control of the attention, hyperactivity, impulsive behavior and executive functions; circuits these, that are modied in ADHD carriers. a driving simulator; two studies were conducted in cars in usual driving situations. All reviewed studies concluded that the use of MPH improved signicantly driving performance in patients with ADHD. In one study, OROS MPH signicantly improved driving conditions compared to placebo and to mixed amphetamine extended release salts. In all studies no signicant side effects of MPH were observed. Conclusion: A signicant improvement in driving performance after treatment with MPH was observed, both in male and female patients, and in teenagers and adults. Nevertheless, methodological limitations such as sample size, daily drug dosage and measurement of driving skills (simulators) should be considered. The literature on this subject is still scarce, making further studies necessary.

P-17-09 Does Biphentin have a signicant clinical impact on attentional networks in individuals with ADHD? K. Saliba*, U. Jain, R. Tannock * Milton, Canada Objective: To investigate the effects of pharmacological treatment on controlled attention in adults with Attention Decit Hyperactivity Disorder (ADHD). Method: This project forms one component of a collaborative largerscaled randomized controlled trial designed to evaluate effects of a long-acting medication (MLR methylphenidate, which is a widely used treatment for ADHD) on the driving performance of adults with ADHD. The project will enroll 30 adult participants with ADHD. Participants are recruited from the Adult ADHD clinic at the Centre for Addiction and Mental Health (CAMH), following a comprehensive diagnostic assessment to ensure eligibility based on pre-specied inclusion/exclusion criteria. Medication dose is optimized following study procedures prior to participating in my component of the project. Participants undergo a 48-hour washout period (from medication), prior to commencing the study protocols. Participants are then assessed under two conditions: placebo and their optimized dose of active medication, which are administered using randomized and multiple-blind procedures. The controlled attention measure is administered at the University of Guelph, where the driving simulator is located. Following a baseline practice of all measures, participants are administered either placebo or their optimized dose of active medication prior to completing the cognitive measure (the well-validated computer, Attentional Network Task [ANT], that assesses three separate neuronal networks - the alerting, orienting and executive functioning network) four times, at both assessment sessions. Results: Correlational and mixed between-within subjects analysis of variance will be conducted to test the hypothesis concerning: the effects of medication on controlled attention and ADHD symptoms. To date, 23 participants have completed the protocol, and the remaining 7 have been recruited and will complete the protocols over the next 1-2 months, allowing the data to be analyzed and the project to be completed prior to the conference. Conclusion: The economic costs of ADHD are substantial. This research will provide the rst empirical investigation of MPH effects on controlled attention in adults with ADHD.

P-17-08 Driving performance of patients with Attention Decit Hyperactivity Disorder (ADHD) after treatment with methylphenidate (MPH): systematic review of randomized controlled trials M. A. Gobbo*, M. Louza * Sao Paulo, Brazil Objective: To review randomized controlled trials (RCTs) on the effect of methylphenidate (MPH) in driving performance of patients with ADHD. Method: Search in PubMed, Lilacs and Cochrane databases, using the following terms ADHD, driving, methylphenidate. Inclusion criteria: RCTs. Exclusion criteria: case reports, reviews, observational trials. Results: Seventeen studies were found. After review, seven RCTs were considered for analysis. All patients were diagnosed according to DSV-IV criteria. All RCTs used a crossover design. Six studies were placebo controlled (one of these compared OROS MPH with mixed amphetamine extended release salts and placebo), one compared immediate release MPH with OROS MPH. Six studies were double-blind; one single-blind. In ve studies the sample size was smaller than 20 patients; the other two studies included respectively 35 and 53 patients. Drug dosage varied from 10 mg/day to 120 mg/ day of short-acting MPH and from 18 mg/day to 144 mg/day of OROS MPH. Three studies included both male and female patients; four, only male patients. Three studies evaluated teenager patients; four studies were conducted with adults. Five of the seven trials used

P-17-10 Predictive factors for more than 3 years duration of central stimulant treatment in adult ADHD: A retrospective, naturalistic study T. Torgersen*, B. Gjervan, H. M. Nordahl, K. Rasmussen * Trondheim, Norway

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159 Objective: In spite of effective short-term central stimulant (CS) treatment of ADHD symptoms in adult ADHD, there is evidence for early discontinuation of the treatment in many patients. We wanted to study the duration of CS treatment in a Norwegian cohort of adult ADHD, and identify predictors for long treatment duration (C3 years). Method: The data were based on the medical records of a sample of 117 out of all 119 adult ADHD patients diagnosed over a period of 8 years in a specic catchment area, and treated with CS. A logistic regression model was applied to identify possible predictors for long treatment duration. Results: The sample was severely impaired in terms of comorbidity, educational achievement and employment. However, the median duration of CS treatment was 33.0 months. Use of extended release (ER) formulations of methylphenidate (MPH) predicted long treatment duration positively; OR 4.420 (1.875-10.419), while baseline antisocial personality disorder (APD) predicted long treatment duration negatively; OR 0.210 (0.085-0.518). Conclusion: This study showed that it is possible to treat severely impaired and highly comorbid adult ADHD patients with CS over years. The nding that ER formulations of MPH predict long treatment duration supports previous research, and it is important to show this association in naturalistic samples like the present. reduce the risk. This study is a double blind within subject controlled design using multilayer release methylphenidate (MLR MPH) at optimized doses in adult ADHD patients. A major component of this study is to assess the longtidudinal changes within the day using cognitive measures. Previous studies focus more on the on-task capacity in the evenings only and do not regard subject fatigue states after a long driving period. This would be akin to a long distance driver who must maintian greater vigilance. MLR MPH, a long acting psychostimulant, has not been investigated using this procedure but, as it uses the active primary ingredient, methylphenidate, it is likely to have comparable efcacy. Method: Thirty referrred patients selected from a major metropolitian city (Toronto) were recruited for this study and assessed at a University-based teaching-research hospital (Centre for Addiction and Mental Health) though the actual study was conducted at the University of Guelph. The subjects were randomized to the study drug versus placebo. The subjects would be put through a driving simulator and at regular intervals would be measured on various cognitive and clinical measures. The same protocol would be repeated with the other preparation on a successive weekend. Results: At the time of submission, all of the patients have been recurited for the study and the majority have completed the actual study procedures and, except for two patients, all have been optimized on their doses. The patients were typically dosed between 20-80 mg of MLR MPH which is consistent with the literature on this product. Conclusion: This is a complex study involving a long day of testing (starting early morning and ending after midnight) and is unique in the study design. It has already been established that psychostimulant medications are useful in on-task capacity but the uniqueness of the study design allows for a critical analysis of certain parameters that may be factors that make this a more compelling rationale for why it happens.

P-17-11 Relapse of comorbid substance use disorder during central stimulant treatment in severe adult ADHD T. Torgersen*, B. Gjervan, K. Rasmussen, H. M. Nordahl * Trondheim, Norway Objective: Central stimulant (CS) therapy is a cornerstone in treatment of ADHD. Substance use disorder (SUD) is a common comorbid disorder in adult ADHD and might complicate the remission of adult ADHD. Our objectives were to investigate the prevalence of relapse of SUD during CS treatment and to identify variables that could predict such relapse. Method: The collection of data was based on a naturalistic, retrospective approach using the medical records of a sample of 117 adult patients diagnosed with ADHD in a specic catchment area over a period of 8 years, and treated with CS. A logistic regression model was applied to identify possible predictors of relapse. Results: Most patients with comorbid SUD (58.5%) relapsed during CS treatment, and the relapses often led to termination of treatment. Younger age (p=0.039) and comorbid antisocial personality disorder (p=0.040) were positively related to relapse, while remission for more than 12 months (p=0.026) and living with a partner (p=0.015) were negative predictors. Conclusion: The clinician should treat comorbid SUD as a separate disorder, and try to obtain a stable and long remission period before introducing CS treatment for adult ADHD. CS treatment in patients with comorbid SUD requires multimodal intervention.

Friday, 27 May 2011, 14.3016.00 P-18 Pharmacological treatment: Adults II

P-18-01 Psychopharmacological treatment of ADHD patients older than 50 years - A pilot study M. B. Lensing*, P. Zeiner, S. Opjordsmoen * Oslo, Norway Objective: ADHD is a well-established diagnosis in children and adolescents. The condition can persist into adulthood. Short-term treatment with medication is found to be effective in most children, adolescents and younger adults. However, little is known about the effectiveness of treatment in adults over 50 years of age with ADHD. In this pilot study we therefore studied: 1) whether adults over 50 years of age ever had used medication for their ADHD and 2) if so, what did they report about treatment effects? Method: A short questionnaire survey was performed among members of the National ADHD patient organization in Norway. Subjects 50 years or older with ADHD were included. Subjects on long-term medication (the great majority with stimulants) were compared with those who had stopped treatment. Chi-square and independent t-tests were used in the statistical analyses. Results: The eligible number of participants was 251. A total of 153 (61.0%) answered the questionnaire, more females (58.8%) than males. The mean age was 55.8 years (SD 4.4), and the mean age when ADHD was diagnosed, was 50.3 (5.9) years. A majority (88.8%) had been treated with medication, and 71.9% were still on this treatment when entering the study. Subjects on medication reported

P-17-12 Driving risk in adult ADHD patients U. Jain*, K. Saliba, R. Yoon * Toronto, Canada Objective: Adult ADHD patients have driving risk and numerous studies have shown that the likely problems are related to executive functioning decits connected to the core symptoms of ADHD namely attention and impulsivity. ADHD patients have a higher rate of accidents, speeding infractions, and moving violations. Accumulated evidence points to a role using psychostimulant medications to

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160 signicantly fewer symptoms of impairment with respect to hyperactivity (p=0.001), impulsivity (p=0.000), and inattention (p=0.000). They also reported better general health (p=0.023), better work capacity (p=0.038), better work motivation (p=0.003), and better ability to manage daily life activities (p=0.004). Conclusion: In adults with ADHD 50 years of age and older, treatment with medication seems to be in use and effective. Medication is associated with reports of signicant symptom reductions and improved daily functioning. Method: This multicentre trial enrolled adults (aged 1855 years) with ADHD on LDX (C6 months; 30-, 50-, or 70-mg/day nal dose at entry), with an ADHD Rating Scale IV with adult prompts (ADHDRS-IV) total score \22, and ratings B3 on the Clinical Global Impressions-Severity (CGI-S) scale. Following a 3-week open-label phase (OLP; LDX 30-, 50-, or 70-mg/day), subjects who maintained responder status were eligible to enter a 6-week double-blind RW phase (RWP) to continue on their OL LDX dose, or switch to placebo. The primary efcacy outcome was proportion of adults having ADHD symptom recurrence (C50% increase in ADHD-RS-IV score and C2 rating-point increase in CGI-S vs RWP baseline score). Safety/tolerability was also evaluated. Results: The OLP included 122 adults; 116 were randomized (LDX, n=56; placebo, n=60) and included in the efcacy analysis. At endpoint, a signicantly (P\0.0001) smaller proportion of adults taking LDX met criteria for ADHD recurrence and were withdrawn (8.9%; 5/56) versus placebo (75%; 45/60). Four subjects taking LDX and 26 taking placebo met ADHD recurrence criteria after 1 week of treatment in the RWP. At 2 weeks, 10 additional participants taking placebo and 0 taking LDX met criteria. During the RWP, 38.8% of 116 subjects (27 LDX, 18 placebo) had a treatment-emergent adverse event. Conclusion: Subjects receiving long-term LDX treatment demonstrated maintenance of efcacy versus placebo upon RW. ADHD symptoms tended to recur early following discontinuation of LDX in the RWP, mostly by 2 weeks. The LDX safety prole was consistent with previous studies and long-acting stimulant use.

P-18-02 A pilot study on the effects of nicotine on attention and concentration in students with adult ADHD symptomatology S. Sayce*, A. Burke * Johannesburg, South Africa Objective: The aim of this study is to explore the effects of nicotine on the attention and concentration levels young adults with Adult ADHD. Method: In order to meet the aims of this study, a quasi-experimental design was utilized. In order to investigate what the extraneous variables may be, a pilot study was conducted rst. A group of four participants were selected on the basis of their use of nicotine (in the form of a cigarette), and one for the use of a hookah pipe. In order to measure attention and concentration, the following three subtests on the CANTAB were selected: Motor Control Task, Rapid Visual Information Processing Test, and the Stop Signal Test. The participants were asked to refrain from using any nicotine products for a period of 12 h prior to the study. The CANTAB tests were administered, where after they were asked to smoke a cigarette. The literature indicates that nicotine that is inhaled starts affecting the brain within 10 20 s after inhalation. Based on this, the participants were required to retake the CANTAB test immediately after they stopped smoking. Results: The results of the pilot study indicated that there is a signicant improvement in attention, concentration and impulse control after inhaling nicotine. These results are, however, extremely tentative due to the small sample size. As the research is still continuing, more reliable data will be available in the near future. Important lessons were, however, learnt from the pilot study, which will be incorporated into future experiments. These include: Refraining from smoking for 12 h may be too excessive, and nicotine withdrawal may have an impact on the initial assessment. In future, participants will only be required to abstain for 4 h. Smoking a hookah pipe for 60 min is excessive, and 7 min (equal to smoking a cigarette) should be sufcient. A second post-test, 2 h after smoking will be done in order to assess long term affects. Conclusion: Results of this study may explain why adults with ADHD are prone to abusing nicotine products.

P-18-04 Long duration of efcacy of lisdexamfetamine dimesylate, the rst prodrug for Attention Decit Hyperactivity Disorder M. Gasior*, S. Wigal, T. Wigal, J. Gao, C. Richards * Wayne, USA Objective: To evaluate the duration of action of lisdexamfetamine dimesylate (LDX) in paediatric and adult subjects. Method: The duration of LDX effect was evaluated in children (612 years) and adults (1855 years) in one parallel-group and two crossover studies. In the former, children were randomized to LDX 30, 50, or 70 mg/day with forced titration, or placebo, for 4 weeks. Study visits occurred once weekly during the treatment phase. In the latter two studies, subjects were titrated to an optimal LDX dose (up to 70 mg/day) during a 4-week optimization phase, followed by a 2-week double-blind crossover (LDX 1 week, placebo 1 week). Children and adults were evaluated once weekly in a highly structured controlled environment (laboratory school or adult workplace environment); assessments were conducted up to 13 h postdose in children and up to 14 h postdose in adults. All statistical tests were 2-sided and performed at the 0.05 signicance level. Results: 230 of the 290 subjects randomized completed the parallelgroup study. Use of the Conners Parent Rating Scale-Revised: Short Form (CPRS-R) demonstrated that LDX was effective throughout the day (i.e. from the rst observation [10a.m.] until the nal observation [6p.m.]). Of the 117 paediatric subjects randomized, 111 completed the laboratory school study. LDX was effective from 1.5 to 13 h postdose based on results for the SKAMP deportment (behaviour) subscale (SKAMP-D), attention subscale (SKAMP-A), total SKAMP score and PERMP scores. Of the 127 subjects randomized, 103 completed the adult crossover study. LDX was effective from 2 to 14 h postdose based on the PERMP. Conclusion: In all three studies, the efcacy of LDX allowed for coverage into the evening hours for children and adults, as measured by behavioural and performance measures, respectively.

P-18-03 Maintenance of efcacy of lisdexamfetamine dimesylate in adults with Attention Decit Hyperactivity Disorder: randomized withdrawal design M. Gasior*, M. Brams, R. Weisler, R. Findling, M. Hamdani, M. C. Ferreira-Cornwell * Wayne, USA Objective: To evaluate maintenance of efcacy of lisdexamfetamine dimesylate (LDX) using a double-blind, randomized withdrawal (RW) design in adults with ADHD on stable treatment. The RW design minimizes time off active treatment and is recommended by the European Medicines Agency.

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161 P-18-05 Metadoxine - a novel non-stimulant extended-release drug for treating adhd I. Manor*, Y. Daniely, D. Meggido, R. Yamin, A. Weizman * Tel Aviv, Israel Objective: Metadoxine (pyridoxol L-2-pyrrolidone-5-carboxylate), an ion-pair salt of pyridoxine and pyrrolidone carboxylate, is approved in some countries for use in the treatment of acute and chronic alcohol intoxication. Our pre-clinical studies suggest that Metadoxine affects the Serotonin receptor family and modulates hyperactive behavior. These and additional ndings led us to propose a therapeutic role for Metadoxine in ADHD. Method: A 40-person adult (32.1 6.9 years) ADHD study has been conducted in our clinic. All subjects were dosed with a single 1400 mg dose of Extended-Release Metadoxine (ER-Met). Subjects were diagnosed with ADHD using DSM-IV criteria, and according to international standards. Subjects were tested before and 90 min after dosing using the computerized Test of Variables of Attention (TOVA). Results: Among others, the TOVA ADHD score increased from a mean of -4.9 to a mean of -1.8 (SE=2.1, p\0.001), and response time variability increased from a mean of 68.9 to a mean of 86.5 (SE=9.5, p\0.001). In WAIS-R, the correct symbol identication test score increased from a mean of 34.7 to 37.9 (SE=1.6, p\0.001) and the symbol search score increased from a mean of 74.6 to a mean of 81.8 (SE=2.5, p\0.001). All subjects reported minimal to no side effects. Conclusion: An extension trial in a similar population (n=10) established the sustained effect of ER-Met using similar endpoints, with consistent improvement shown at both the 4 h and 7 h time points. A 6-week Phase IIb study (multi-center, randomized, doubleblinded parallel placebo-controlled) in 120 subjects is now ongoing in order to further establish ER-Met safety and efcacy in this indication. Conclusion: ADHD is a highly prevalent disorder with signicant functional impact that often persists into adulthood. There is very little data comparing different stimulant treatments. Although the current observational ndings have limitations, they will undoubtedly contribute to increasing our understanding of the treatment of ADHD.

P-18-07 Pharmaceutical treatment of Attention Decit Hyperactivity Disorder (ADHD) in adults an overview of available studies and the medical situation in Germany based on a health technology assessment D. Benkert*, K.-H. Krause, J. Wasem, P. Aidelsburger * Sauerlach, Germany Objective: Attention Decit Hyperactivity Disorder (ADHD) is a mental disorder. An established form of therapy is using stimulants medications, most commonly, containing Methylphenidate as the active ingredient. However, in Germany this ingredient is not approved for adults suffering from ADHD. In the following Health Technology Assessment, the situation of studies regarding adult ADHD as well as available medical care, are discussed and viewed from different perspectives Method: In August 2009, a systematic literature search was performed in relevant scientic databases to the efcacy and costeffectiveness of the medical treatment of ADHD in adults as well as the ethical, social and legal aspects in regard to society and care. Results: Nineteen studies fulll the inclusion criteria: nine randomised controlled trials, ve meta-analyses, three economic studies and two studies relevant to legal aspects. Studies show pharmacutical treatment to be signicantly efcient in treating adult ADHD, especially for methylphenidate, amphetamine, dextroamphetamine and bupropion - as compared with placebo in patient-relevant endpoints. The average annual medical expenses for an adult with ADHD were between 1,270 and 1,619 Euro. The legal issues related to ADHD, generally, revolve around the use of stimulant medication, since stimulants fall under the category of narcotics. Particularly the legal aspects of stimulant use in regard to driving, traveling, performing military service and doing competitive sports must be considered. From societys perspective, a growing acceptance of drug-treatment for adults with ADHD is to be expected in the healthcare policy environment. For example, on the Internet pages of the ADHD information portal quick tests and knowledge tests on the topic ADHD can be conducted. Conclusion: An early start of pharmacological treatment of ADHD is economically and politically highly relevant because of the social disadvantages, high risk of developing other mental disorders and high costs for society.

P-18-06 The effect of OROS methylphenidate and long-acting amphetamine salts on cognitive tasks in adults with Attention Decit Hyperactivity Disorder: An open trial with blind placebo control comparison T. Simon*, M. Bilodeau, M. Beauchamp, R. Elie, P. Lesperance, S. Dubreucq, J.-P. Doree, S. V. Tourjman * Montreal, Canada Objective: To compare the effect of different stimulant medications on cognitive tasks in adults with Attention Decit Hyperactivity Disorder (ADHD). Method: Following a clinical trial with ADHD subjects, participants were clinically stabilized on long acting stimulant medication between August 2009 and January 2011 at the Centre Hospitalier Universitaire de Montreal and the Fernand-Seguin Research Center. Thirteen adults with ADHD without signicant comorbidity were treated sequentially with OROS methylphenidate (Concerta) and long-active mixed amphetamine salts (Adderall-XR). Once stabilized at optimal dosage, subjects completed subtests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) assessing spatial working memory, attention and inhibition. Results were then compared to those obtained from fteen subjects treated with placebo during the initial double-blind study. Results were analysed using a 3 9 3 MANOVA. Results: Preliminary results will be presented. The expected result is a greater improvement on the CANTAB tests with stimulant medications compared to placebo. The improvement with the two stimulant medications might show differences on specic CANTAB tests.

P-18-08 Pharmacological treatment for ADHD in adults: The Italian reality B. Plattner*, E. Duregger, A. Conca * Bolzano, Italy Objective: In January 2010 the Department of Psychiatry in Bolzano/ Italy opened the rst Italian ADHD center for adults. The real challenge were and still are legal restrictions in prescribing off-labeldrugs even if the evidence for their efciency exists. Method: We report two cases in which the conditions of legal and nancial restriction demonstrated an important clinical impact as well

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162 as clinically relevant pieces of information where obtained under alternative pharmacological regimes. In the rst case the legal contest was the determining one to switch from Methylphenidat to Bupropion. Patient A, male, age 21 was diagnosed with ADHD in his rst decade. Medication was changed from Methylphenidat to an increasing dose rate of Bupropion until reaching 450mg/d. Medication was taken at 13:00 to reach maximum plasma levels while the patient was attending evening school. He works out 2h/d, attends group therapy and weekly personal coaching. Patient B, male, age 20, was diagnosed with ADHD as an adult after having experienced severe problems in school and in diverse relationships. He was initially treated with Bupropion as monotherapy in normal dosage. Due to a partial response (positive impact on nicotin and alcohol consumption) comedication with Methylphenidat was successfully implemented in a gentleman agreement with the pharmacist. Results: Patient A reported equal concentration ability with Methylphenidat retard and Bupropion. Initial hypersensivity to external stimuli decreased rapidly. Bupropion yielded not the same result in Patient B so that comedication with Methylphenidat was deamed necessary. In both cases the response was of clinical relevance and increased the social functioning and stable occupational setting as well as stable relationships. Conclusion: Legal restrictions severly hamper state of the art treatement of adult ADHD patients in Italy and demand a change in professional and political attitude regarding this mental illness. diagnosed with co-morbid GA. Analysis involved the two treatment groups (stimulants and non-stimulants). Detailed analysis of the relationship between ADHD symptoms, anxiety symptoms, and functional impairments scores before and after treatments utilizing the repeated measures multivariate analysis of variance (MANOVA) with will be presented. Conclusion: Both stimulants (amphetamine salts, and atomoxetine, are effective in reducing disability in adult ADHD patients suffering from comorbid GAD, and both were overall well tolerated.

P-18-10 Individualized dosing with OROS Methylphenidate to optimize treatment in adults with Attention Decit Hyperactivity Disorder B. Schaeuble*, H. L. Starr, R. B. Armstrong, Y.-W. Ma, S. Ascher * Neuss, Germany Objective: To evaluate efcacy and safety of individualized dosing of OROS MPH in adults with ADHD. Method: Randomized, double blind, placebo controlled parallel group study including adults with ADHD with an AISRS score [24. Individualized daily dose (OROS MPH 18, 36, 54, or 72 mg or matching placebo) was determined with a goal of AISRS score \18 during a 4-week dose adjustment period; patients then maintained their dose for 14 days. Changes in AISRS scores (the primary outcome) from baseline to nal visit were analyzed using ANCOVA. Results: Of 341 patients in the intent-to-treat population (OROS MPH, 169; placebo, 172), 162 (47.5%) were female. Mean age was 35.8 years. Percentages of patients with each nal OROS MPH dose were 18 mg: 13.6%, 36 mg: 23.1%, 54 mg: 24.3%, and 72 mg: 39.1%. Mean (SD) baseline AISRS scores were 37.8 (6.94) for OROS MPH and 37.0 (7.51) for placebo. The OROS MPH group had signicantly greater improvement than the placebo group in AISRS scores (17.1 [SD=12.44] vs. 11.7 [SD=13.30], P\0.001). Adverse events reported by C10% of patients were headache, dry mouth, and decreased appetite in the OROS MPH group and headache in the placebo group. Of the randomized subjects, 8/178 (4.5%) in the OROS MPH group and 5/179 (2.8%) in the placebo group withdrew because of adverse events. One serious adverse event occurred in the placebo group. No deaths occurred. Conclusion: Individualized dosing of OROS MPH with the goal of symptom remission resulted in greater ADHD symptom reduction than placebo treatment.

P-18-09 Functional impairments of adult ADHD patients with or without co-morbid generalized anxiety before and after treatment with stimulants or non-stimulants: A Comparative naturalistic study S. Mousa*, A. Gabriel * Calgary AB, Canada Objective: Substantial proportion of patients with ADHD may suffer from comorbid anxiety. The main objective is to examine and compare functional impairments in adult ADHD patients with or without Generalized Anxiety Disorder (GAD), treated with stimulants or nostimulants. Method: Consenting adult ADHD patients (n= 88) participated in this open label naturalistic study. Of the total number of patients (n = 62, 70%) had signicant comorbid anxiety symptoms (HAM-A [ 7). There were (n = 57, 65%) treated with stimulants (amphetamine salts or lisdexamfetamine dimethylate) and (n = 31, 35%) treated with the non-stimulant atomoxetine. All those suffering from GAD failed to respond to 8 week trials of SSRIs, or SNRIs prior to the adjunctive treatment with stimulants or atomoxetine. The primary effectiveness measure were the Sheehans disability scale, and the WEISS functional impairment rating scale self-report (WFIRS-S). Other scales included adult ADHD self report scale (ASRS-v1.1) symptom checklist, the Clinical Global Impression severity subscale (CGI-S), Hamilton anxiety scale (HAM-A). Baseline measures prior to the treatment with stimulants and atomoxetine were compared to those at 4, 8, and at 12 weeks of treatment. Monitoring for pulse, blood pressure and weight changes was carried out at baseline and at endpoint. Results: All patients completed this open label naturalistic study. There was signicant and robust resolution of symptoms of all effectiveness measures, including the symptoms of anxiety, as shown by changes from baseline in ASRS-v1.1, HAM-A, and CGI at 8 weeks in patients treated with stimulants or with atomoxetine. Also there was signicant reduction in disability scores on both the clinician rated Sheehans disability scale and the self report WFIRS-S scales at 12 weeks. However patients without comorbid anxiety were less impaired at both baseline and at 12 weeks than patients who were

P-18-11 Oros methylphenidate and patient-reported work-related outcomes in adults with Attention Decit Hyperactivity Disorder B. Schaeuble*, S. Ascher, Y.-W. Ma, H. L. Starr * Neuss, Germany Objective: To assess patient-reported work outcomes in adults with ADHD. Method: Double-blind, placebo-controlled, dose titration study of OROS MPH in adults with ADHD (1865 years). Subjects were randomly allocated to 6-week treatment with placebo or OROS MPH. Doses were initiated at 18 mg/d with weekly 18-mg increases to a total AISRS score of less than 18 or maximum dose of 72 mg/d. Efcacy outcomes included the investigator evaluated AISRS and the Endicott Work Productivity Scale (EWPS) which is a 25-item, selfreport questionnaire that assesses feelings and behaviors at work that affect productivity and efciency. Low scores indicate low negative impact on work productivity and efciency. Results: 341 patients were included in the ITT population (OROS MPH, 169; placebo, 172). Mean (SD) baseline AISRS scores were 37.8

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163 (6.94) for OROS MPH and 37.0 (7.51) for placebo. The OROS MPH group had signicantly greater improvement than the placebo group in AISRS scores (17.1 [SD=12.44] vs. 11.7 [SD=13.30], P\0.001). Mean (SD) baseline values for EWPS were 46.2 (17.1) and 44.7 (19.6) for OROS-MPH and placebo group respectively. The LS mean changes from baseline to endpoint for the EWPS were 18.2 (OROS group) and 11.7 (placebo group). The LS mean change difference between treatments was 6.5 points, (nominal p=0.008). Adverse events reported by C10% of patients were headache, dry mouth, and decreased appetite in the OROS MPH group, and headache in the placebo group. Of the randomized subjects, 8/178 (4.5%) in the OROS MPH group and 5/179 (2.8%) in the placebo group withdrew because of adverse events. One serious adverse event occurred in the placebo group. Conclusion: Treatment with OROS MPH improved self-reported feelings and behaviors contributing to work productivity and efciency, important components of health and productivity management. OROS MPH was generally safe and well tolerated. suggest that Neurofeedback offers similar results as the standard drug treatment in the improvement of ADHD symptoms.

P-19-02 Determining the effectiveness of reality therapy on reducing depression amongst mothers with children aficted with Attention Decit Hyperactivity Disorder M. Darini*, P. Azizi khereshki, H. Davoodi * Tehran, Iran Objective: Attention Decit Hyperactivity Disorder (ADHD) is the most common neuro-behavioral disorder in childhood. And in order to improve social and emotional interactions of these children who suffer from ADHD a great deal of psychological interventions are required from which one of the most inuential programs is parent mass education.The objective of this study is to determine the efciency of mass education program of reality therapy on reducing depression (ADHD) amongst mothers. It should be mentioned that the adopted sampling method is multi-stage cluster sampling and the selected subject group for this research is consisted of mothers who have children aficted with ADHD and are residence of Tehran. Method: In this procedure 24 of the individuals who gained higher average scores in one Beck depression questionnaire -21 questionswere randomized in to two groups of 12 individuals, one as control group while the other as experimental group. Both groups received mass reality therapy through eight 2 h sessions. Both groups were tested and evaluated two times (pre-test, post-test). Results: The study of results obtained from analysis of covariance using statistical-tests veries the efciency of mass reality therapy in reduction of depression amongst mothers with children aficted with ADHD. Conclusion: With regard to the effectiveness of reality therapy in comparison with other therapeutic approaches, it is strongly recommended to the mothers who own children contracted ADHD to consider this approach for their children.

Friday, 27 May 2011, 14.3016.00 P-19 Non pharmacological treatment: Children and adolescents I
P-19-01 Neurofeedback and standard pharmacological intervention in the improvement of Attention Decit Hyperactivity Disorder symptomatology: Preliminary ndings V. Meisel*, G. Garca-Banda, E. Cardo, M. Servera, P. Aggensteiner, T. Perez, J. Picardo, I. Moreno * Palma de Mallorca, Spain Objective: Many studies have shown that Neurofeedback could be an alternative treatment for Attention Decit Hyperactivity Disorder (ADHD). However, this intervention has not been commonly recognized as an efcacious treatment for ADHD due to the important methodological limitations that many of these studies have. We present preliminary data of a randomized, controlled, and open study that aims to determine the efcacy of Neurofeedback compared to standard pharmacological intervention for the treatment of ADHD. Method: This project is a multicentric study (University of Seville and Univesity of Balearic Islands) that evaluates the level of improvement of ADHD symptomatology with the following assessments: pre-treatment or baseline assessment, 3 assessments during treatment, post-treatment and 2 follow-up assessments. These assessments included several behavior rating scales completed by teachers and parents. The data presented here refers to 8 participants (7 -12 years old), and their pre-treatment and post-treatment assessments. Neurofeedback training was conducted over a period of 20 weeks with 2 sessions per week, using an Atlantis II 2 9 2 Brain Master. The training consisted in supressing Theta (4-8 Hz) while increasing Beta (12-20 Hz). Results: As expected, the pharmacological intervention group improved in 10 of the 12 evaluated variables. The improvements on inattention according to mothers and teachers, and hyperactivity according to teachers,were almost statistically signicant. On the other hand, participants in the Neurofeedback group also improved in 10 of the 12 assessed variables. The improvements on the functional impairment measures and hyperactivity for fathers, inattention for mothers, and reading and reading comprehension for teachers were almost signicant. Conclusion: Although these results are not signicant, both treatments show a tendency of improvement. Theses preliminary ndings

P-19-03 Effect of music training and movement on redusing the symptoms of attantion decit hyperactivity disorder M. Esteki*, Z. Atashkar * Tehran, Iran Objective: The present study is conducted to investigate the effect of music training and movement on decreasing the symptoms of Attention Decit Hyperactivity Disorder. Some studies show that music therapy for children with Attention Decit Hyperactivity Disorder can improve their cognitive skills such as attention and memory, and play an important role to decrease the impulsivity behavior. Rhythmic movement for harmonic and regularity that they have can affect on perception and attention of the children with hyperactivity disorder. Method: Memory test, attention test and Leiter-R questionnaire are used at this study. The present study is experimental with pre-test and post test method and control group. Statistical population is all and boys at the age of seven ten with Attention Decit Hyperactivity Disorder referred to clinics of saveh city. The size of session was 50 and the sample size was 20 that selected randomly from clinics and divided into 2 group experimental and control groups. For training music, Orff method was used. Therapy was for 15 session. T Test and covariance analyze used to analyze the information. Results: Results indicated the music training and movements have effect on decreasing the symptoms of Attention Decit Hyperactivity

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164 Disorder so music along with movement can be used to decrease the symptoms of this disorder at school and home. Conclusion: Music and movement play an important role in training and treatment in ADHD. These are enjoyable work for children. So it is better to use it for treatment of childeren. period and becoming more efcient in dealing with time-wasters; organization of the studying space, including personalized courses in language, English and art therapy and assigning a personal tutor. Results: The center offers support for all learning disabilities, such as dyslexia, dyscalculia and dysgraphia. The center is run by professionals from academia, a center manager who is a learning disabilities expert, a psychologist who specializes in diagnosing and treating learning disabilities, an occupational therapist, an expert in handwriting, organization for studying and sensory processing related difculties, an assistance technologies expert and student tutors. Each student with a learning disability and/or attention decit disorder arriving in EIC is assigned a personalized assistance package to suit his/her unique needs. Conclusion: The EIC model has been recognized by Israels Ministry of Education and EIC centers are to be nowadays found in a few postprimary schools.

P-19-04 Changes in omega 3/6 fatty acid plasma proles in a randomized placebo-controlled study in children and adolescents with ADHD M. Johnson*, J.-E. Mansson, S. Ostlund, G. Fransson * Goteborg, Sweden Objective: Background: A small number of studies have examined fatty acid proles in plasma or red blood cells in children with ADHD and controls suggesting that children with ADHD have lower Omega 3 blood levels and higher n-6/n-3 ratios than controls. Objective: Assess baseline levels and changes in plasma fatty acid proles in children and adolescents with ADHD, participating in a placebocontrolled study with Omega 3/6 supplementation, and relationships between fatty acid measures and treatment response. Method: 75 children and adolescents aged 8-18 years with DSM-IV ADHD were randomized to 3 months of Omega 3/6 (Equazen eye qTM) or placebo, followed by 3 months of open phase Omega 3/6 for all. Plasma fatty acids (n-3, n-6, n-6/n-3 ratio, EPA and DHA) were measured at baseline, 3 and 6 months. Results: Subjects with a clinically meaningful reduction of ADHD symptoms (more than 25%) at 3 or 6 months were classied as 3-month responders or 6-month responders. At baseline, there were no signicant differences in mean n-3, n-6, n-6/n-3 ratio, EPA or DHA across the active and placebo group or across responder and non-responder group (but the 6-month responders tended to have a higher baseline n-6/n-3 ratio). The 0-3 month changes in these parameters were signicantly greater in the active group (p\0.05). The 6-month responders had signicantly greater changes than non-responders in n-3 at 3 months (increase) and in n-6/n-3 ratio at 3 and 6 months (decrease). Conclusion: Omega 3/6 supplementation had a clear impact on plasma fatty acid levels in the active group. A signicant correlation was found between treatment response and plasma fatty acid changes. The most pronounced shifts were seen in the n-6/n-3 balance.

P-19-06 Creativity training effects upon concept map complexity of children with Attention Decit Hyperactivity Disorder (ADHD): An experimental study K. Alkahtani* * Riyadh, Saudi Arabia Objective: To extend the knowledge about creative thinking among children with Attention Decit Hyperactivity Disorder (ADHD) via investigating the effects of creativity training upon concept mapping prociency. Method: A pretest-posttest control group design was used. In order to ensure that concept mapping is a familiar technique to all participants (students aged 9-10 years and diagnosed as having ADHD), they all were given a training session in concept mapping. Next to that, they were asked to complete a concept map (CM) and Torrance Tests of Creative Thinking (TTCT) as a pre-test measure. They then were assigned to either experimental or control group, and the experimental group was given creativity training. Finally, all participants completed a second CM and the TTCT as a post-test measure. Results: The post-test scores for the two groups were signicantly different on the TTCT (t=3.450, P=0.001) and on the CM (t=6.690, P=0.0001) indicating that the participants who received creativity training displayed signicantly higher post-test scores at the 0.01 level compared to the control group. A strong positive correlation was also found, for the pre-test scores was (r=0.961, P\0.0001) and for the post-test scores was (r=0.878, P\0.0001). This correlation shows a signicant relationship at the 0.01 level between the students scores on the TTCT and CM in both the pre-test and the post-test. Conclusion: Maps of the students in the experimental group point to a deep learning and understanding which resulted from the change in their learning strategies. They used different thinking skills and learning strategies to read, understand, and map the text. The maps constructed by those students reected changes in their conceptual understanding which was evidenced by a higher number of concepts and cross-links. Therefore, they should not be excluded from having the opportunity to develop their potential of being creative personnel.

P-19-05 Empowerment and Insight Center for students with learning disabilities and ADHD O. Tykochinsky*, A. Frishman Shetrit * Hod Hasharon, Israel Objective: Empowerment & Insight Center (EIC) was established at the Kibbutzim College of Education in order to assist and empower students with learning disabilities and ADHD. Each year, EIC assists 330 Kibbutzim College of Education B.Ed students. EICs vision is to offer our students the opportunities to realize their intellectual and personal potential and develop their unique skills, so that they may contribute in the eld of education. Method: The center follows the Human occupational model, which focuses on three components: the persons components, the component of the occupation and the components of the environment. The goal is to promote a level of participation and success in studying with minimal effort and with maximum concentration in studying. The center offer students aid in the following areas: improving occupational skills, including learning accommodations and assessment accommodations; time planning and organization, which includes a monthly and weekly planning, getting organized during the exam

P-19-07 Cognitive behavioral therapy in the treatment of children with Attention Decit Hyperactivity Disorder L. F. Coelho*, M. C. Miranda, D. L. F. Barbosa, S. Rizzutti, M. Muszkat, S. M. M. Palma, F. Rosangela, F. Dias, O. F. A. Bueno * Sao Paulo, Brazil

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165 Objective: The cognitive behavioral therapy (CBT) is the most studied modality of non-medicated treatment in patients with Attention Decit Hyperactivity Disorder (ADHD). However there are no CBT records to be used in groups, which could be useful for health centers. To analyze the efciency of a CBT group protocol in the treatment of the behavioral and cognitive symptoms in children with ADHD. Method: A CBT program for the treatment of children with ADHD was elaborated containing 20 two-hour sessions, being 40 min with the parents and 1 h and 20 min with the children. The used techniques address: psycoeducation, parents training, routine elaborations, token economy, planning, auto-instruction, problem-solving and an exercise in social abilities. The protocol was applied in a group of ve ADHD boys, with average age of 9,5. It was used methylphenidate LA 20mg during the treatment. The pre and post treatment evaluation was composed by the following cognitive and behavioral instruments: DSM-IV criteria, Continuous Performance Test (CPT), ve subtestes from Automated Working Memory Assessment (AWMA), Behavior Rating Inventory of Executive Functions (BRIEF), Child Behavior Checklist (CBCL) and Child Behavior Evaluation Scale for Teachers (Conners Scale). Results: It was held a qualitative analysis of the scores in the scales answered by the teachers in which it was veried that has decrease of the hyperactivity manifestation, attention and anxiety at school, increasing the socialization capacity, behavioral regulation and metacognition. In the parents scales it was noticed the decrease of the internalizing and externalizing scores. About the cognitive aspects there was an improvement in all attentional and working memory performance. Conclusion: A group of ve children will be included and will be reevaluated in March, 2011, so the relevant conclusions to this study, which means the improvement of the cognitive and behavioral symptoms, will be submitted together with the current data. Objective: Group-therapy for adolescents with AD(H)D are not established in the treatment standardized. Barklay described a pro gram in 2009. In 2010 Sprober investigate a SAVE cognitivebehavioral group-therapy program at the University of Ulm. Helinger, Philippsen and Ebert developed a cognitive-behavioral grouptherapy with young adults at the University of Freiburg. Method: The scope of our therapy approach with adolescents with AD(H)D is an interactive focus. As a result of the symptoms of AD(H)D, problems themselves come along with others. Moreover children, adolescents and adults are often not noticed their own symptoms. With reference of systemic, interactional-analytical and cognitive-behavioral elements of group-therapies we carried out 8 sessions. We worked with two therapists and used media like movies, homework, reciprocal observation, describing and correcting each other. We tried to drew attention the symptoms into the therapyinterventions. Therefore the patient should take the role of the therapist or change their perspectives. But to generalized signicance of situations into the therapy to real daily problems was very difcult for adolescents and superimposed by the dysfunctions of AD(H)D. Our study population include adolescents with severe youth psychiatric problems. We integrate all patients with co-morbid disturbing. Exclusion criteria were acute addiction, autism spectrum disorders or criminal trials. Results: From May to September 2010 we realized 10 sessions. All participants were motivated to continue and want to prolonged the therapy after 8 sessions. 3 months after nish the therapy, we invited the adolescents and their parents. We discussed the intervention, whether there was an effect or not, and, what works from the point of view of the youth and their parents or were dysfunctional. Education about AD(H)D in adolescence, structuring and self-management strategies were useful, but interactive interventions like breaks, group-works and role-playing sustainable, because the youth noticed their own thoughts, emotions and pattern of reaction during reections of role-playing or reciprocal descriptions. Conclusion: Up to now we cant give a prognosis, whether our approach of a group-therapy with adolescents lead to reduction of symptoms in daily routine. Below study results show an impression of positive side effects like self organisation regarding the sessions in our hospital, contacts with the others outside the sessions. Interactive interventions show possibilities the youth to involve into the therapy. It should be useful strategies to motivate youth persons with AD(H)D to tackle with their own problems.

P-19-08 An experiential-based psychotherapeutic plan for Attention Decit Hyperactivity Disorder in children G. Cucu-Ciuhan* * Pitesti, Romania Objective: The paper presents the results of a controlled study that had the purpose to test the efciency of a complex experiential-based psychotherapeutic plan for the treatment of ADHD. Method: This psychotherapeutic plan combines metaphorical scenarios adapted for therapeutic intervention in small groups of hyperactive children with special groups of professional optimisation organised for the teachers of these children. The subjects were 40 children diagnosed with ADHD, combined type. Results: One-way ANOVA showed that there is a signicant difference between the four groups on each criterion (p \ .05). Bonferoni Post-hoc multiple comparisons tests showed that this difference is due to the mean scores for the control group, signicantly different from the experimental groups. Conclusion: Results show that group experiential psychotherapy leads to a signicant global behavioural progress in the case of children diagnosed with ADHD. Teachers participation in a professional optimization group leads to a signicant behavioral progress of children in their class diagnosed with ADHD.

P-19-10 Treatment of ADHD in affected mothers and children a randomized controlled multicentre trial: Patient enrolment and basic characteristics of the study sample T. Jans*, C. Jacob, K. Hennighausen, E. Graf, M. Rosler, S. Haenig, E. Sobanski, L. Poustka, M. Colla, R. Burghardt, A. Philipsen * Wurzburg, Germany Objective: The objective of our randomized controlled multicenter trial is to evaluate whether the treatment of maternal ADHD improves the efcacy of a behavioural parent training for childrens ADHD. Method: 144 mother-child-pairs - both affected by ADHD according to DSM-IV - were treated or are currently under treatment at ve study sites in Germany. Mothers were randomized to cognitivebehavioural group psychotherapy plus open methylphenidate treatment or to control treatment (supportive counselling). After 13 weeks of treatment of the mothers behavioural parent training is administered to all mother-child-pairs on a weekly basis for 12 a period of weeks. The primary endpoint of the trial refers to the change in the childrens externalizing symptoms from baseline to week 26 (after parent training).

P-19-09 InterActIVE: An approach of group-therapy for adolescents with AD(H)D T. Krause* * Munchen, Germany

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166 Results: Last patient out will take place in May 2011. Therefore, outcome data will not be open to the study group until June 2011. At the time of abstract submission data clearing was still under progress with respect to screening and baseline data. Data on patient enrolment and basic characteristics of the study sample will be presented. Conclusion: To our knowledge our study is the rst randomized controlled trial on a combined treatment of ADHD in affected mothers and children (CCT: ISRCTN73911400, source of funding: German Federal Ministry of Education and Research - BMBF 01GV0605). Conclusion: Results indicate that sustained attention performance of children with ADHD will improve with computer-based attention training.

P-19-15 What changes in preschoolers with ADHD symptoms after a 14 week parental intervention: Preliminary results A. Azevedo*, M. J. Seabra-Santos, M. F. Gaspar, T. Homem, S. Leitao * Coimbra, Portugal

P-19-13 Children with ADHD attended outpatient clinic and day care program: The impact of psychosocial intervention A. Al Ansari* * Manama, Bahrain Objective: Evaluation of the effectiveness of psychosocial intervention in comparison to the usual outpatient management. Method: Design: Retrospective/cross section design. Method: Children aged 5-16 years, received DSM IV ADHD diagnosis and spend at least 4 weeks of treatment including medication for the years 2006-2009 constitute the study sample, outpatient (n=20), Day care (n=15). A blind investigator reviewed patient clinical notes and documented evidence of changes in clinical symptoms. The investigator interviewed therapist/nurse for their assessment of degree of improvement. The unit social worker contacted or visited mothers for the same. Results: The two groups didnt differ on sex distribution, parents education, social class and source of referral. More children from day care group were from non-intact family (P=.036). Mothers reported marked improvement among both groups. Blind investigator and therapist/nurse found more improvement among those received more intense psychosocial intervention (P=.018). Conclusion: Cases attended day care service had more psychopathology compared with those from out patient clinic. The staff and blind investigator reported better improvement among children attended the day care program. This indicates that difcult ADHD cases benet more from an intense psychosocial intervention in addition to medication.

P-19-14 Effects of computer base of attention training on sustain attention performance in children with Attention Decit Hyperactivity Disorder S. Bakhshi*, E. Pishyareh, F. Behnia, V. Nejati * Tehran, Iran Objective: The aim of this study was to investigate the effect of computer-based attention training in children with Attention Decit Hyperactive Disorder. Method: Eighteen children with Attention Decit Hyperactive Disorder were selected by multi-stage cluster random sampling from Tehran psychiatry and occupational therapy clinics. Children in experiment group received ten 1 h sessions computerized attention training while the control waiting list group did not received any treatment. Before and after training all participants assessed with continuous performance test and parent form of conners rating scale. Results: Results showed signicant improvement in sustained attention performance (p=0/000) and impulsivity (0/021) in the experiment group. Mean reaction time did not show any signicance alterations. Also signicant improvements were seen in conners total score (p=0/ 000), learning problems subscale (p=0/003) and, hyperactivity index (p=0/00).

Objective: With the increase of preschoolers diagnosed with ADHD, and the cautious recommended in the use of pharmacological treatment in young children (Sonuga-Barke et al., 2006), psychosocial interventions that include parent training hold promise as a treatment tool for this age (Webster-Stratton & Reid, 2010). The purpose of this study is to evaluate the efcacy of the Incredible Years Basic Parent Training Program (IY; Webster-Stratton, 1989) in a sample of Portuguese preschoolers with ADHD symptoms. Method: 42 participants between 3-6 years of age scoring above the borderline or clinical cut-off points on the ADHD markers of the Strengths and Difculties Questionnaire (SDQ; Goodman, 1997), Werry-Weiss-Peters Hyperactivity Scale (WWP; Routh, 1978), or Parental Account of Childs Symptoms (Taylor et al., 1991). Families were randomly allocated to either an IY intervention group (IG; n=22) or a waiting-list control group (CG; n=20). Measures were administered in both groups at baseline and 6 months later. Intervention: IY was delivered in groups of 9-12 parents, through 14 weekly sessions by experienced group leaders. Pre-post results of two primary outcome measures (SDQ, WWP) were analyzed, and Nonparametric Tests (Wilcoxon, Mann-Whitney) were used. Results: Regarding the IG, results from the pre-post comparison indicate: signicant differences in the level of parent-reported overall difculties (p=0.040) and ADHD behaviours (p=0.025). There were no signicant differences in the pre-post comparison of the CG; nor between groups, either on pre or post results. However, when comparing the groups according to the amount of change that occurred from the pre to the post test, results indicate a signicant difference in the WWP (p=0.043) after intervention. Conclusion: Results must be carefully interpreted taking into account the small sample size. Nevertheless, preliminary results suggest that in the short term (6 months), intervention was associated with more positive outcomes for children, as reported by parents after IY, suggesting that this could be an effective intervention for preschoolers with ADHD symptoms. To clarify the intervention impact, future studies must include: larger randomized samples; different informants; secondary outcome measures (parenting skills; parent-child interaction) and extension of the follow up to a broader period of time.

Friday, 27 May 2011, 14.3016.00 P-20 Non pharmacological treatment: Children and adolescents II
P-20-01 Cognitive rehabilitation using Pay Attention! Program in children with ADHD D. Barbosa*, M. C. Miranda, M. Muzskat, S. Rizzutti, S. M. M. Palma, O. F. A. Bueno * Sao Paulo, Brazil

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167 Objective: In ADHD - that has great negative impact in the daily therapeutic intervention becomes necessary. Pay Attention! A Childrens Attention Process Training Program intends to treat the difculties of sustained, selective, alternating and divided attention (Sohlberg & Mateer, 1989 and 2001). Than, this study described the efcacy of the intervention program using Pay Attention! analyzing cognitive and behavioral symptoms before and after treatment. Method: In the rst phase of the study, 10 children (M=9,86; SD=2,45) were assessment by medical criteria for ADHD and a neuropsychological battery was performed. The second phase contained the training using Pay Attention! in 20 individual sessions accomplished once a week. In the third and last phase, the efcacy of the program was analyzed by comparing results on neuropsychological tests and behavioral scales before and after the intervention, using the following measures: Conners Continuous Performance Test (CCPT), Automated Working Memory Assessment (AWMA), Behavior Rating Inventory of Executive Functions (BRIEF), Child Behavior Checklist (CBCL) and Child Behavior Evaluation Scale for Teachers (Conners Scale). Children were medicated with methylphenidate during the treatment and their families participated of a parents orientation program in group. Data were analyzed by Wilcoxon test. Results: The analysis of the results showed signicant better performance in some attention measures, like: CCPT: (Clinical% Z=2,49; p=0,013), (Omissions Z=2,54; p=0,011), (HitRT Z=2,80; p=0,005), (HitRTSE Z=2,80; p=0,005), (Variability Z=2,80; p=0,005), (HitRTBlock Change Z=2,59; p=0,009), (HitRTISI Change Z=2,39; p=0,017), (ResponseStyle Z=2,19; p=0,028). There were also differences in BRIEF (BehavioralRegulation Z=2,12; p=0,034) and CBCL (AggressiveBehavior Z=1,955; p=0,051). Conclusion: The results indicate better speed and orientation of the attention and behavioral adjustment. Than, basis on this study is possible establishing that the attentional training using Pay Attention! has possibility to show efciency for the ADHD treatment. daily activities and academic situations. More success, less failure, and nally more positive evaluations led to a decrease in aggression, anxiety and other behavioral problems in general among the children in this study.

P-20-03 Effects of combined treatment on Turkish children diagnosed with Attention Decit Hyperactivity Disorder: A 12-month follow up study E. S. Ercan*, A. Kutlu, S. Durak, U. Akyol Ardic * Izmir, Turkey Objective: The aim of this study was to investigate the effects of combined treatment on children diagnosed with Attention Decit Hyperactivity Disorder (ADHD). Method: After careful screening, 67 children (55.8%) diagnosed with ADHD ? oppositionaldeant disorder (ODD) and 53 children (42.2%) diagnosed with ADHD ? conduct disorder (CD) were included in the study. Treatment consisted of ongoing medication (methylphenidate) management and a parent-training program that continued for 12 months. Children were assessed in multiple domains by multiple sources of information at baseline and at the end of the 1st, 6th and 12th months by parent- and teacher-completed the Turgay Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV)-Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S), Conners Parent Rating Scale (CPRS), and Conners Teacher Rating Scale (CTRS). Mother-child relationship was assessed by the Parental Acceptance and Rejection Questionnaire (PARQ). Results: Combined treatment was effective in reducing the ADHD, ODD, and CD symptoms. Analyses of the data revealed that medication, rather than parent training, was responsible for the improvements both in the symptoms and in the mother-child relationship. Conclusion: The results of the study, in line with the Multimodal Treatment Study of Children with ADHD (MTA) ndings, highlighted the role of stimulant medication in the long term treatment of ADHD.

P-20-02 The effectiveness of using Perceptual-Motor Practices on behavioral disorder among ve to eight year old children with Attention Decit Hyperactivity Disorder F. Dehghan*, E. Pishyareh, F. Behnia, N. Amiri, M. Safarkhani * Tehran, Iran Objective: The present study investigates the effectiveness of using perceptual-motor skills on the decrease in behavioral disorders of ve to eight year old children with ADHD. Method: In this quasi-experimental study, 26 ve to eight year old children with ADHD referred to four occupational therapy centers were randomly divided into an experimental and a control group. Research instruments included Parents Rating Scale (CPRS-48), Child behavior check list (CBCL), Bruninks Oseretsky Test of Motor Prociency (BOMT). After the intervention, which included a six week perceptual-motor practice, mothers were asked to ll out the behavioral checklists again. BOMT was used for post-intervention assessment. Results: At the end of the intervention period all motor component scores (gross movements, ne movements, upper limb speed and dexterity and total score) showed signicant improvement. Behavioral disorders (anxiety, social problems, attention problems, aggressive behaviors and others) also showed signicant improvement. In addition, children in the control group showed signicant improvement in ne movement and BOMT total score, as well as a decrease in aggressive behaviors and anxiety. Conclusion: The improvement of motor skills in children in this study appears to have resulted in a feeling of competency as well as

P-20-06 A study of combined treatments in cognitive and behavioral symptoms of children with ADHD M. Miranda*, M. Muszkat, S. Rizzutti, L. F. Coelho, D. Barbosa, O. Bueno * Sao Paulo, Brazil Objective: The aim of this study is to analyze the benets of multimodal treatment of Attention Decit Hyperactivity Disorder (ADHD), so: a) analyzes the effects of isolated treatments (use of methylphenidate) and combined treatments to the use of medication as cognitive-behavioral therapy (CBT), family intervention and cognitive training in cognitive and behavioral symptoms of children with ADHD. b) also discuss current cognitive training techniques for attention and working memory training. Method: Forty ADHD- diagnosed children aged 7-14 were divided into 4 groups to be subjected to the following procedures: the children are assessed by neuropsychological and clinical criteria of ADHD and after exclusion criteria are randomized into four treatment groups: group 1 - children only make use of methylphenidate long-acting medication; group 2 - methylphenidate and training of attention using Pay Attention!; group 3 - methylphenidate and working memory training; group 4 - methylphenidate and cognitive-behavioral group.

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168 All groups received family intervention. Children are evaluated pre and pos-treatment by the following instruments: DSM-IV criteria, Continuous Performance Test (CPT), ve subtestes from Automated Working Memory Assessment (AWMA), Behavior Rating Inventory of Executive Functions (BRIEF), Child Behavior Checklist (CBCL) and Child Behavior Evaluation Scale for Teachers (Conners Scale). Results: Outcomes in terms of efcacy of the interventions are being analyzed in relation to performance on neuropsychological tests and behavioral scales before and after intervention (nished March, 2011), which will enable us to objectively analyze the efcacy for both cognitive and behavioral symptoms Conclusion: The results of this study and discussion of these aspects will help acquire new knowledge of techniques and instruments for intervention ADHD children. P-20-07 Effectiveness of guided parental self-help for parents of children with ADHD: An interim report on the study sample L. Mokros*, N. Benien, M. Dopfner * Koln, Germany Objective: The present study is based on positive results of two pilot studies about the efcacy of guided parental self-help (GPSH) for parents of children with ADHD. Parents receive manuals with contents based on a German self-help book (Wackelpeter und Trotzkopf) and additionally a biweekly counselling telephone call. About 200 parents are included in the program. The objective of the presentation is an interim analysis of the sample-characteristics. Method: About 200 parents of 6-12 year old children with ADHD are investigated in a one-group pre-post design. Physicians from private practices across the whole county enrolled parents with a diagnosis of ADHD. Results: The sample was analyzed on ADHD-symptoms as well as socio-demographic factors, sex, age, and residential area at study entry. As expected a high proportion of the patients were male. A high variance regarding symptom-severity could be detected. Conclusion: Preliminary ndings of GPSH are promising. Yet, more research is needed to provide GPS for parents of children with ADHD in a broader context. P-20-10 Eye movement and cognitive training in children with Attention Decit Hyperactivity Disorder A. Orylska*, J. Sarzynska, H. Lubanski * Warsaw, Poland Objective: The aim of the research is to examine the effectiveness and gain deeper knowledge of the attention and memory training combined with neurofeedback in children with Attention Decit Hyperactivity Disorder (ADHD), age 10-15 . Method: Half of the participants of the research is underaging 3-5 times per week up to 20 sessions of cognition functions training (namely the memory and attention training: Memory Updating Spatial, Multielement Visual Tracking). The remaining half shall undergo sessions on EEG-biofeedback with special emphasis on C3-C4 and Fp1-Fp2 spots/points. To estimate the effectiveness of the training and its impact/effect on the performance of attention, the participants is examined pre and post tests (control attention and inhibit measure) with the ANT attention test this test involves examination using the eye-tracker which provides information whether patients suffering from ADHD have a specic pattern of eyeball movement and whether the proposed training can affect this pattern. Results: We assume that the cognitive functions training combined with sessions on the EEG-biofeedback is improved the performance of attention. Conclusion: Attention and memory training could potentially have positive impact on patients functioning in society and family. The adoption of eye-tracker testing shall allow to verify the hypothesis that the cognitive training may affect the way in which ones brain functions.

P-20-11 Attention training in children with Attention Decit Hyperactivity Disorder J. Sarzynska* * Warsaw, Poland Objective: The aim of the research was to examine the efciency of the attention training in children with Attention Decit Hyperactivity Disorder (ADHD) Method: Children aged from 8 to 12 years were divided into two groups the rst clinical group comprised of 20 children with diagnosed ADHD, the second consisted of 40 healthy children. All the subjects undergone 10 training sessions, during which they performed a series of especially designed computer tasks testing their resistance to distractions. To verify the effectiveness of the training as well as to examine its effect on attention and other cognitive functions, the subjects performed D2 attention tests and Raven Progressive Matrices Test for children before and after the training sessions. Results: As a result in children from both the clinical and the control group a statistically signicant improvement in performance of the attention test was observed. Furthermore the children from the clinical group improved their performance in the intelligence test. Conclusion: It may indicate, that functioning of attention does not have a direct effect on the performance in the intelligence test, but the limitation of vulnerability to distractions in children with ADHD helps them to cope with this type of tasks. Moreover, training of cognitive functions might improve the performance of patients with ADHD in school and social life.

P-20-12 Incredible years parent training program in ADHD: Parents attendance and satisfaction M. J. Seabra-Santos*, M. F. Gaspar, A. Azevedo, T. Homem, M. Pimentel * Coimbra, Portugal Objective: Although parent training programs have proven effective in the reduction of ADHD symptoms in preschoolers, a major concern is how to engage and retain parents in such programs which, in turn, are conditions of their effectiveness. The purpose of this study is to analyse the experience with the use of the Incredible Years Basic Parent Training Program (Webster-Stratton, 1989, 2001) in Portugal. Method: Subjects: 97 parents of preschoolers, who participated in the Incredible Years Program (IY). Some of the IY groups comprised parents whose children dont have any known risk factors (nonclinical groups NCGs, n=46 parents); other groups were attended by parents whose children were above the borderline or clinical cut-off points on the ADHD markers of the Strengths and Difculties Questionnaire, Werry-Weiss-Peters Hyperactivity Scale, or Parental Account of Childs Symptoms (clinical groups CGs, n=51 parents). Intervention: The IY was delivered in groups of 8-12 parents, through 12-14 weekly sessions. The attendance rates and levels of satisfaction regarding the program and its different methods (e.g. explanations given by group leaders, DVDs, discussion in group, role-play) and strategies trained (e.g. play, praise, ignore, clear commands, time-out) were analyzed and the Student t test was used to compare groups. Results: The high attendance rates observed in both groups are associated with the facilitating conditions offered to parents (e.g. babysitting provided to children, snacks in the middle of sessions). The

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169 high levels of satisfaction observed are discussed in discussed in terms of some specic characteristics of the program (e.g., clear contents, group leader skills, supportive and non-evaluative relationship with group leader and other group members). When compared to parents of NCG, parents of CG consider more useful the use of role-play in group sessions and the strategy of time-out, which may be attributed to the specic difculties they face when interacting with their children. Conclusion: Regarding attendance rates and satisfaction levels, the IY Program is a good choice to use with families of Portuguese preschoolers with symptoms of ADHD. of the most difcult children in local schools in a combined health/ education collaborative initiative. Method: After working out issues of implementing wraparound in the local scene, children who were unable to be managed within local schools despite maximum behaviorual support, were referred through the schools to the Edwrap team. Data gathering, assessment, planning, implementation and evaluation of outcomes then took place over variable periods of time.. The parents were key players and involved at each stage of the process from assessment to plan development and consistency in management across life domains was a key feature overall Results: 186 children were referred from Oct 2006 - June 2010, and 149 accepted into the process: 48 of those accepted did not enter the process. 40 had entered and transitioned on and another 36 remain within the current workload and are ongoing. 6 are long term clients with ongoing issues. Others moved from the area or withdrew from the service. More than 80% had a diagnosis of ADHD plus comorbidities. 80% were male. The mean age was 8.6 years with range of 5 - 14 years. 58% were reintegrated with the education process within 6 - 15 months, and tranistioned back to normal support within their schools. SDQ data (strengths and difculties questionnaire) shows improvement overall with signicant variability from child to child. Fewer days lost from school and fewer adverse events were documented. Conclusion: Implementing a contextualized wraparound process has proved successful in a combined health/education collaborative process for this most difcult group of children in local schools. Reengagement with education has been achieved in the majority most of whom have ADHD, and other measures of improvement including fewer adverse events at school are evident. It has proved exible in allowing for signicant variation in the implementation of plans and focusing on individualized outcomes. While there have been signicant issues in contextualizing wraparound process to the Australian scene, the outcomes for this group of children has been very good, although access to further funding especially for behavioural interventionists would assist the process further.

P-20-13 Comparison of effectiveness of three treatment methods for adolescents with Attention Decit Hyperactivity Disorder (ADHD) and executive function disorder (EFD): A phenomenological study R. Weaver* * Wayland, USA Objective: The objective of this phenomenological study was to evaluate and compare the effectiveness of three short-term nonmedical treatments of adolescents with ADHD and EFD. Method: The three methods of treatment were: Cognitive Dichotomy Therapy (CDT), a cognitive treatment method, Systems of Fair Exchange (SOFE), a behavioral treatment method, and Self Advocacy Method (SAM), an educational/communication treatment method, all of which have been developed and utilized at the Weaver Center by this examiner over the last two decades. The method employed 12 families with students considered to be underachieving by parents and teachers. Students were controlled for social/economic class, age, intellect, diagnosis, medicine usage and given eight weekly treatment sessions of one of the three treatment methods. Results: The results indicated that the three methods were described as signicantly improving the young adults and parents condence, health, self-esteem, optimism of future, reduction of stress within the family and increase of academic productivity. The SOFE provided the most immediate positive results, however following the study without monitoring and continued therapy demonstrated the briefest positive effect. The CDT had a moderately positive effect with a modest duration of benet. SAM demonstrated the most positive and the longest lasting benet. Conclusion: The conclusions indicated that behavioral interventions had the quickest response time and did not endure because of its initial effectiveness, CDT had a signicant benet on independence and autonomy and was useful in sustaining behavioral change, and the most enduring therapy was SAM, as it included individual education regarding strengths and liabilities of having such diagnoses, behaviorally practiced compensatory strategies, and communication skills. These individuals became more independent and empowered when they advocated for themselves successfully. These methods showed promise for reducing adjustment co-morbidities.

Friday, 27 May 2011, 14.3016.00 P-21 Non pharmacological treatment: Adults

P-21-01 Micronutrients reduce stress and anxiety in adults with ADHD after a 7.1 earthquake A. P. Julia Rucklidge*, A. Boggis, J. Johnstone, R. Harrison * Christchurch, New Zealand Objective: The Objective was to study the role of nutrition, (in the form of Micronutrient supplementation), in the recovery from the emotional responses associated with experiencing a 7.1 earthquake, in a population of adults with ADHD. Method: The 7.1 earthquake occurred in the context of ongoing trials of New Zealand adults with ADHD taking a micronutrient supplement (EMP?). The earthquake provided an opportunity to use a real-life stressor to compare mood, anxiety and stress responses of adults with ADHD who were and were not taking the micronutrient supplement at the time of the earthquake. We expected that those participants who were consuming the micronutrients at the time of the earthquake would show a stronger emotional recovery compared with a sample of adults with ADHD not taking micronutrients. Thirty-three adults with ADHD were assessed twice following the earthquake using a measure that had also been completed prior to the earthquake (baseline). Seventeen were not taking micronutrients at the time of the earthquake (control group), 16 were (micronutrient group).This time period was characterised by intensive after-shock activity with on-going heightened arousal and

P-20-14 To utilise wraparound process in a combined health/ education initiative (EdWrap) in the management of children presenting with major behavioural/learning problems in local schools N. Wooleld*, W. Chan, P. Cooper * Wamuran, Australia Objective: To evaluate the outcomes of implementing a contextualized wraparound process when this was utilized in the management

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170 sleep disturbance in the general population. Necessary Ethics approval was acquired. The measure used was The Depression Anxiety and Stress Scale (DASS) which is a 42-item questionnaire which assesses an individuals current severity of symptoms relating to depression, anxiety and stress with well established psychometric properties.Statistical measures used included MANOVA, Paired sample t tests and Independent sample t tests (two-tailed) . Results: While there were no between-group differences one week post-quake (Time 1), at two weeks post-quake (Time 2), those taking micronutrients reported signicantly less anxiety and stress than those not taking micronutrients (effect size 0.69). These between group differences could not be better explained by other variables, such as baseline measures of emotions, gender, ethnicity, socio-economic status, intelligence, age, ADHD type, or co-occurring disorders. Further, while there was no signicant change from baseline to Time 2 for the control group (effect sizes ranged from 0.11-0.45), there were signicant changes in all areas assessed for the micronutrient group (effect sizes ranged from 0.73-1.01). Conclusion: The results suggest micronutrients may increase resilience for individuals with ADHD to ongoing stress and anxiety associated with a traumatic event and are consistent with a growing body of evidence supporting micronutrient use as a tool in treating mental health problems. Method: Six adult ADHD patients from the Toronto area received a novel therapy adjunctive to medication and CBT between 2009-2011. Entitled Narrative Schema Realignment, the technique is introduced at time diagnosis and continued through CBT. The method relies on patient identication with culturally universal and psychologically derived narrative archetypes and where the patient is cast as hero of their own evolving epic narrative. The diagnosis and negative schema align with the role of villain. A familiar redemption story arc is then chosen or created by the patient as a framework to progressively guide away from negative schema and into positive realignment through therapy. Results: Based on subjective reports, and compared subjectively to similar patients not offered the technique, more consistent subjective improvements were reported and were achieved in fewer sessions. Improvements in self esteem and self condence were the most commonly reported benets. One patient had difculty initiating the technique due to poor insight and difculty aligning with a known storyline or character. This patient responded well when asked to create an original story and character instead. Conclusion: Narrative Schema Realignment represents a potentially useful CBT adjunct to for adults with ADHD who are prone to negative schema development and the resultant maladaptive behaviours and distortions. Some of the advantages may include enhancement of the therapeutic alliance through the experience of shared narrative, the establishment of a framework conducive to speculation and role play, the ability to recontextualize aspects of the psychotherapeutic or CBT experience into a more appealing or engaging experience for patients with ADHD who are particularly responsive to novelty, external structure, and activation of interest provided by this technique. This promising technique would therefore benet from a study design involving a greater number of patients, a matched control with a sham adjunct, and formal measures of progress.

P-21-02 First results of the COMPAS group (Comparison of Methylphenidate and Psychotherapy in adult ADHD study) E. Graf*, S. Matthies, M. Colla, S. Gro-Lesch, T. Jans, E. Sobanski, B. Alm, A. Philipsen, M. Huss, B. Kis, M. Roesler * Freiburg, Germany Objective: Attention Decit Hyperactivity Disorder (ADHD) is a serious risk factor for co-occurring psychiatric disorders and negative psychosocial consequences in adulthood. Given this background, there is great need for an effective treatment of adult ADHD patients. Method: Therefore, our research group has conducted a rst controlled randomized multicenter study on the evaluation of disordertailored DBT-based group program in adult ADHD compared to a psychopharmacological treatment. Between 2007 and 2010, in a fourarm-design 433 patients were randomized to a manualized dialectical behavioural therapy (DBT) based group program plus methylphenidate or placebo or clinical management plus methylphenidate or placebo with weekly sessions in the rst twelve weeks and monthly sessions thereafter. Therapists are graduated psychologists or physicians. Treatment integrity is established by independent supervision. Primary endpoint (ADHD symptoms measured by the Conners Adult ADHD Rating Scale) is rated by interviewers blind to the treatment allocation (Current Controlled Trials ISRCTN54096201). The trial is funded by the German Federal Ministry of Research and Education (01GV0606) and is part of the German network for the treatment of ADHD in children and adults (ADHD-NET). Results: First results on baseline data including socio demographic and clinical characteristics including co morbid disorders of the whole study population are presented.

P-21-04 The effects of the French Version of the community parent education program for families of preschoolers with behaviour problems: A pilot study N. Leblanc*, L. Ben Amor, P.-A. Desmarais, L. Archambault, R.-C. Duval, P. Bouchard, J. Martel, M. Simoneau * Quebec, Canada Objective: To evaluate the effects of the French version of the COPE on child behavior problems, parenting competence, and parent-child attachment. Method: Families of children, 3 to 5 years old, were recruited via community health service centers. The COPE consisted of 10 weekly 2-hour sessions, including homework assignment and review, watching videotaped vignettes and identifying common parenting errors, discussing potential solutions, and modeling and role playing strategies. The topics for each session were: (1) praise and attending, (2) rewards, (3) planned ignoring, (4) transitional warnings, (5) whenthen statements, (6) planning ahead, (7) point systems, (8) time out, (9) time out from reinforcements-loss of privileges, and (10) problem solving. An activity-based social skills program was conducted for children during parenting sessions. Child behavior problems were measured using the Child Behavior Checklist 1.5-5. The Parenting Stress Index was used to assess parenting variables. Parents completed these questionnaires before and after the program. T-tests were used to compare pre and post mean scores, with p \ 0.01. Results: A total of 25 parents (72% mothers) and 18 children (77.8% boys) participated in the study. A highly signicant improvement in sleep problems (p = 0.009) and attention decit/hyperactivity problems (p = 0.005) was observed in children. Parents reported feeling

P-21-03 The hero with a million faces: Narrative schema realignment in adult ADHD I. Szpindel* *Toronto, Canada Objective: To introduce a narrative based psychotherapeutic adjunct for accelerating and enhancing schema reconstruction and CBT for the adult with ADHD.

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171 more competent (p = 0.005), less isolated (p = 0.001), and less depressed (p \ 0.001); thus globally less stressed (t(17) = 3.40, p = 0.002). They also indicated high levels of satisfaction with the COPE. Conclusion: Psycho-educational interventions may be an important tool to improve behavior problems in preschool children. to enable health care workers from various professional backgrounds to accompany and coach ADHD individuals according to particular needs in various areas of life. Results: The presented university based 12 months qualication program adresses health care workers and therapists from various professional provenance (social workers, teachers, psychologists) who want to acquire specic knowledge and professional skills in order to be able to particularly support the ADHD individuals conduct of life. The curriculum includes broad basics of etiology, diagnostics, differential diagnosis, fundamentals of treatment approaches, and deep insight into various training programs. Emphasis is put on transition from adolescence to adulthood, on important aspects of social law and on the acquisition of supervised individual coaching experience. The respective modular courses will be held and supervised by renowned experts from medicine, psychology and social sciences. Conclusion: With the decided professional qualication as an ADHD coach, potential participants will be put in a position to accompany individuals along their paths of life and encourage their particular decisionmaking and responsibility as an essential part of multimodal treatment.

P-21-05 A randomized controlled study of a manualised cognitive behavioral treatment for medicated adults with ADHD B. Emilsson*, G. Gudjonsson, J. F. Sigurdsson, G. Baldursson, H. Olafsdottir, E. Einarsson, S. Young * Reykjavik, Iceland Objective: The primary aim of this study was to measure the efcacy of a novel CBT programme for medicated adults with ADHD. The primary outcome measures were ADHD symptoms and severity. Secondary outcome measures were anxiety, depression, emotional control, social functioning and antisocial behaviour. In light of positive results of earlier studies on CBT for this population it was hypothesised that those who received the psychological treatment would show signicantly more improvement on the selected outcome measures than those who did not. It was also hypothesised that this effect would be maintained at follow-up. Method: This study was conducted at an outpatient clinic at the Landspitali National University Hospital of Iceland. 54 medicated adults with ADHD and residual symptoms were randomly allocated to an experimental (CBT/MED) treatment condition (n = 27) and a treatment as usual (TAU/MED) control condition (n = 27) that did not received the CBT intervention. The outcome measures were obtained before treatment (baseline), after treatment and at three month follow-up, and included self-reports and ratings by independent assessors. To adjust for differences at baseline an analysis of covariance (ANCOVA) was conducted for each of the dependent variables measuring differences between the conditions in time. Results: Signicant treatment effects were found on measures of ADHD symptoms and antisocial behaviours at the end of treatment with medium to large effect sizes. Signicant and large treatment effects were noted on all the measures at follow-up. Conclusion: The results give support for the growing evidence for the effectiveness of CBT interventions for adults with ADHD. Further, the results demonstrate that the psychological treatment has an additive effect over and above medication alone and improves functions associated with impairment. Further studies on psychological treatments for adults with ADHD are needed.

P-21-07 ADD & loving it?! And www.totallyadd.com: The new media that transforms psychoeduction in ADHD U. Jain*, R. Green, A. Green *Toronto, Canada Objective: ADHD is the most common childhood psychiatric disorder and one of the most common adult afictions yet there are two groups that are difcult to reach: the 13-25 year olds and the ADHD spouses. The website, www.totallyadd.com and the documentary ADD & Loving It?! were specically created to reach the public and, by default, this target audiance. The rst step to any treatment program is to rst educate the client. Method: The multimedia strategy uses a new media tool called Edutainment: education through entertainment. The authors are experts in this eld both in terms of previous work and professional credentials. The task was to create information that was presented with humor, hope and credibility. The rst step was to review existing sources of information. The second step was to create a proposal and have it funded and produced. The third step was to see if the target audiance was reached. The method was to have a membership system and to determine if we were a) reaching our core age demographic and b) how long were they on the site (a very good indication of acceptance and likely learning). Results: Both the site and the documentary are award-winning and highly visible. PBS launched the documentary to 89 stations in the US with over 3000 viewings reaching 98% of the US population. Hits to the website in December 2010 were over 100K and the demographic in question was a signicant component of that group. Conclusion: Websites have global appeal and as English is the worlds language for science and information, it is not surprising that the reach of this website has been Global. In Google searches, it ranks high. This is the new wave of information dissemination. What we know as psychoeducation will have changed.

P-21-06 Multimodal treatment and coaching in ADHD development of an advanced training program P. Greven*, J. Irmscher * Berlin, Germany Objective: Attention decit disorders can no longer be regarded as solely childhood or adolescent disorders. Large numbers of adults still suffer substantially from ADHD symptoms that cause considerable difculties for themselves and their family and social environment but also constitute a notable burden for professional elds, health care and welfare systems. Method: In order to minimize the negative impact of symptoms in the course of ADHD, a variety of training programs have been developped to support individuals, families and health care workers according to requirements during multimodal treatment. It is obvious though that for some individuals there is a need for specic and continuous coaching beyond that. The presented program is designed

P-21-08 ADHD adults incidence of personality disorder and response to treatment with Methylphenidate F. Reimherr*, J. L. Olsen, B. Marchant, R. J. Robison, C. Pommerville, E. D. Williams, C. Halls * Salt Lake City (UT), USA Objective: Personality disorders (PD) are frequently identied in adults with ADHD.1 This study reassesses the incidence of

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172 personality disorder and the treatment response based on the severity of personality disorder symptoms in adult ADHD. Method: 113 subjects who met DSM-IV-TR and/or Utah criteria for ADHD were entered in one of two placebo-controlled crossover trials of methylphenidate.2,3 No attempts were made to include or exclude patients based on personality disorder. PD diagnosis was determined by the clinician using all available information including self-report questionnaires and the SCID-II interview. Subjects were categorized as those with no PD (PDnegative), one PD (PDpositive) and with two or more PDs (PDplus). Symptom severity was measured with the WenderReimherr Adult Attention Decit Disorder Scale (WRAADDS.) Results: 43% were PDnegative, 32% PDpositive and 25% PDplus. Among patients with personality disorders, 16% of subjects had a PD in cluster A, 42% in cluster B, 63% in cluster C and 18% had other PDs. Compared with others, PDplus subjects had higher baseline levels of ED (p\.001). Subjects experienced a signicant treatment effect for the total WRAADDS (d=0.9, p\.001). The PDplus subjects did not show a signicant treatment effect (d=0.3, p=.61) in contrast with PDnegative (d=0.9, p=.002) and PDpositive (d=1.5, p=.004) subjects. This pattern was replicated for the symptom areas of attention?disorganization, hyperactivity?impulsivity, and emotional dysregulation. The interaction between treatment and PD group was signicant for emotional dysregulation (p=.05), but not for the total WRAADDS (p=.062). Conclusion: 57% of subjects with ADHD had a personality disorder. PDplus subjects did not have a signicant treatment response while PDpositive and PDnegative subjects experienced large and signicant treatment effects. The interaction between treatment and PD group was only signicant for the symptoms of emotional dysregulation. This suggests that extensive personality disorder symptoms might limit treatment response to methylphenidate alone in ADHD adults. extradimensional shift (IES: set shifting) and spatial working memory (SWM) promised to be useful for subtyping ADHD children. The best diagnostic validity is to be gained in children between 8 and 10 years, whereas lower rates of diagnostic hits in younger children are revealed. Conclusion: Combining executive functioning questionnaires and respective neuropsychological tasks seems to be a promising way to identify ADHD subtypes and thus, may enable us to reliably differentiate fuzzy kids from those with a clinical diagnosis of ADHD. Even more so, diagnostic reliability increases considerably when merging parent behaviour questionnaires and actual test performance (i.e., the CANTAB subtests SOC, IES, SWM).

P-22-02 ADHD or bipolar disorder-survey of cultural differences in diagnosis between Germany and the USA G. C. Teschke* * Berlin, Germany Objective: The purpose of the study was to see, if there are differences in the perception of ADD/ADHD between German and USAmerican child- and adolescent psychiatrists. Method: A clinical vignette of an 18 years old male youth presumably suffering from AD/ADHD was sent to a randomly chosen sample of 425 German and 350 US-American child psychiatrist with the request as to the most likely diagnosis and the option of an alternative diagnosis. Results: A return rate of 185 of 650 (28,5%) was obtained (125 recipients could not be located). ADD/ADHD was, according to expectations, the most frequently chosen diagnosis (51.7 of the Germans and 42.7% of the Americans opted for it). Surprising was that 22.7% of the Americans opted for bipolar disorder, whereas in Germany nobody considered this likely. The Americans made up for this by seeing ADD/ADHD far more often as an alternate diagnosis, thus reecting a seeming ambivalence about or interchangeability of these two diagnoses. This difference was statistically highly signicant. Conclusion: The results of this study suggest that there is a discrepancy in the perception of ADD/ADHD on both sides oft he Atlantic; whereas inGermany ADD/ADHD is seen as a monolithic disorder, in the USA it is considered overlapping with bipolar disorder. The reasons for these differences are unclear and need to be explored.

Saturday, 28 May 2011, 14.3016.00 P-22 Diagnosis: Children and adolescents II

P-22-01 Just fuzzy kids or ADHD-kids? Diagnostic utility of questionnaires and PC-tests tapping executive functions for ADHD subtyping M. Schoe*, L. Kaufmann, D. Kloo * Linz, Austria Objective: The main aim of the present study is to examine the diagnostic utility of (i) the German version of the Behaviour Rating Inventory of Executive Functions (BRIEF) and (ii) selected PC-supported tasks of the Cambridge Automated Neuropsychological Test Battery (CANTAB) for differentiating subtypes of Attention Decit Hyperactivity Disorder (ADHD). Method: Potential performance differences on executive functions are compared between elementary school children with the clinical diagnoses of ADHD (n = 33) and aged matched controls without ADHD (n=41). Upon using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria, 14 ADHD children could be classied as inattentive, 7 as hyperactive-impulsive and 12 as combined. Moreover, parent information about executive functioning is available for all kids. Results: Findings revealed signicant correlations between all BRIEF scales and subscales and the standard symptom questionnaire for ADHD as provided in DSM-IV. Hence, the latter results closely match the ones reported for the English-language version of the BRIEF. Furthermore, the CANTAB subtests stocking of cambridge (SOC: tapping planning abilities), intra-

P-22-03 The development of screening scales for Attention Decit Hyperactivity Disorder (ADHD) in Thai children and adolescents age 3-18 years C. Pornnoppadol*, V. Piyasilp * Bangkok, Thailand Objective: To develop reliable and valid screening scales called Thai Attention Decit Hyperactivity Disorder Screening Scales (THAI ADHD SS) to screen for Attention Decit Hyperactivity Disorder (ADHD) among Thai children and adolescents age 3-18 years. Method: Thai ADHD SS are newly developed screening scales comprised of 3 versions including Preschooler (age 3-5 years), Child (age 6-12 years) and Adolescent (age 13-18 years) versions. Each version contains 30 items assessing hyperactive-impulsive symptoms (item 1st -15th) and inattentive symptoms (item 16th-30th). The reliability of Thai ADHD SS was evaluated by item analysis, twoweek test-retest and inter-rater reliability assessment as well as internal consistency measurement. Area under curve (AUC) of

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173 receiver operating characteristic curves (ROC curves) was measured to help select the appropriate cut-off point. Diagnostic Interview for Children and Adolescents (DICA)-ADHD section was used as a gold standard to determine the ADHD diagnosis. Sensitivity, specicity, positive and negative predictive value were analyzed to determine the criterion validity. Exploratory and conrmatory factor analyses were also performed to assess the construct validity. Results: Fifteen thousand three hundred sixty subjects (4,608 children, 8,064 parents and 2,688 teachers) participated in this study. All versions of Thai ADHD SS have shown an excellent internal consistency. Cronbachs alpha coefcient ranged from 0.94 0.98. Two-week testretest reliability conrmed the scales stability. Pearsons correlation coefcient (r) ranged from 0.70 - 0.88 (mean = 0.80, p\0.001). When used separately, at T-score [ 61, Thai ADHD SS - self report, parents report and teachers report form- have an AUC of 0.64 (95% CI = 0.56-0.71, p\0.01), 0.74 (95% CI = 0.68-0.79, p\0.001) and 0.61 (95% CI = 0.55-0.67, respectively and have fair sensitivity (0.57 0.63) and specicity (0.49 0.55). When used altogether, at T-score[61, Thai ADHD SS - self report, parents report and teachers report formrevealed good sensitivity (0.90) and specicity (0.88). Factor analysis conrmed that Thai ADHD SS contain two domains including hyperactivity-impulsivity domain and inattentiveness domain. All items have loading factors of more than 0.4. Conclusion: Thai ADHD Screening Scales are reliable and valid screening scales for ADHD and are useful for further clinical or epidemiological study related to ADHD especially when Self-report, Parents report and Teachers report form are used altogether. P-22-05 Is DSM-IV based ADHD self report scale valid and reliable tool for 8 years children? E. Ercan*, E. S. Ercan, R. Kandulu, E. Uslu, C. Aydin * Izmir, Turkey Objective: The current study investigates whether self-reports of children provide reliable and valid information concerning ADHD. For this purpose, we developed Ercan DSM-IV Based ADHD Self Report Scale for elementary school children based on the 18 DSM-VI ADHD symptoms. Method: The validity and reliability of the Ercan DSM-IV Based ADHD Self Report Scale was evaluated in an epidemiologic sample of 171 s grade students (89 ADHD; 82 controls). In the rst stage of the study, 1500 2nd grade students has been screened for the presence of ADHD by using DSM-IV based ADHD Scale. All positive screened students (86) and one-to-one matched controls (except one missing case) were evaluated with a semistructured interview (Schedule for Affective Disorders and Schizophrenia for School-Age ChildrenEpidemiologic Version (K-SADS-E), and all diagnostic decisions made by using best estimate procedure. After the diagnostic evaluation 89 subjets has been classied as ADHD and 82 non-ADHD. Results: Ercan DSM-IV Based ADHD Self Report Scale scores of diagnostic group and the control group were compared and the signicant difference was found between the groups. Item-total correlations and Cronbach-alpha coefcient was calculated to evaluate the item quality and the internal reliability (.85 for attention decit and .84 for hyperactivity-impulsivity subscale). Conrmatory Factor analysis was conducted for studying validity of the scale. A logistic regression analysis was performed using scales on the Ercan DSM-IV Based ADHD Self Report Scale as predictors of membership in the two groups (ADHD vs. non- ADHD). Logistic Regression showed that attention decit subscale classication percentage is 69.4 and the hyperactivity subscale classication percentage is 64. Conclusion: These results suggest that the Ercan DSM-IV Based ADHD Self Report Scale is reliable and valid tool for diagnostic and screening purposes.

P-22-04 Reliability and validity of turgay DSM-IV based disruptive behavior disorders rating scale teacher and parent forms E. S. Ercan*, E. Ercan, R. Kandulu, E. Uslu, C. Aydin * Izmir, Turkey Objective: The aim of the study is to evaluate the reliability and validity of Turgay DSM-IV Disruptive Behavior Disorders Rating Scale in an epidemiologic sample of Turkish elementary school children. Method: 1500 2nd grade students from zmir, Turkey has been I screened for the presence of ADHD by using DSM-IV based ADHD Scale. All positive screened students (86) and one-to-one matched controls (except one missing case) were evaluated with a semistructured interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children- Epidemiologic Version (K-SADS-E), and all diagnostic decisions made by using best estimate procedure. The validity and reliability of the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale Parent and Teacher Forms was evaluated in this study sample of 171 subjects. Results: Item-total correlations and Cronbach-alpha coefcient were calculated to evaluate the item quality and the internal consistency reliability of the scales. Conrmatory Factor analysis was conducted for studying validity of the scales. The internal consistency reliability of the scales was found to be quite high (.92 and .91 for parent form; .97 and .96 for teacher form). Logistic Regression Analysis of Turgay DSM-IV Based Disruptive Behavior Disorders Rating Scale Teacher and Parent Forms revealed that %87.6 correctly classied the diagnostic group, and %91.5 correctly classied the control group. Conclusion: These results suggest that the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale teacher and parent forms are reliable and valid for diagnostic and scanning purposes.

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174 P-22-06 Prevalence of Attention Decit Hyperactivity Disorder in school-aged children of a poor Brazilian community M. Arruda*, M. V. Moura-Ribeiro, J. H. Golfeto, M. E. Bigal, G. Polanczyk * Ribeirao Preto, Brazil Objective: To estimate the prevalence of ADHD in a representative community sample of Brazilian school-aged children, as well as to compare the Mental Health Status of children with and without ADHD. Method: Children from 5-12 years (n = 1,856) were recruited at the public school system (36.7% of the total population of children from 5-14 years living in this city). Parents and teachers were completed the Swanson, Nolan and Pelham Questionnaire - version IV (SNAPIV), a rating scale that lists all 18 symptoms of ADHD according to the DSM-IV. General psychopathology was assessed with the validated Brazilian version of the Child Behavior Checklist (CBCL/418). Results: The overall point prevalence of ADHD was 6.1% (95% condence interval [CI] = 5.0-7.2); it was signicantly higher in children older than 9 years-old (7.6%, relative risk [RR] = 1.9, 95% CI = 1.1-3.2), in boys (7.7%, RR = 1.7, 95% CI = 1.1-2.4) and in those coming from lower social classes (9.1%, RR = 2.2, 95% CI = 1.2-4.0). The RR of CBCL scores in all dimensions, with the exception of withdrawn, were signicantly higher in those with ADHD versus controls. Conclusion: This study assessed large sample of school-aged children from a poor community in Brazil. The detected prevalence is in accordance with estimates found in diverse settings, with different cultural and social characteristics. Children with ADHD were found to be signicantly impaired in several domains of mental health. Health care providers and educators should be adequately prepared to identify and provide medical and educational support to children with ADHD. P-22-08 The latent class analysis of subclinical ADHD symptoms in parent and teacher report A. Kobor*, A. Takacs, R. Urban, V. Csepe * Budapest, Hungary Objective: Previous studies have suggested the importance of dimensional and categorical approaches in understanding Attention Decit Hyperactivity Disorder (ADHD). The high prevalence rate of attention problems in nonclinical samples further indicates the need for identifying subtypes with milder symptoms. Moreover, the role of multiple informants is of high importance when symptom severity is at evaluation. Method: The Hungarian version of Strengths and Difculties Questionnaire (SDQ), suitable for rapid screening of childhood behavioral problems, has been used. The SDQ data were collected both from parents and teachers of 383 and 391 children (age = 8-13 years) of a non-referred sample, respectively. A latent class analysis was applied to the items of the Hyperactivity scale of both versions of the questionnaire. One to six class models were estimated for boys and girls separately. Only those participant who had ratings from both informants (n = 272) were included in the cross-informant analyses, in which the equivalent or similar classes across informants were identied. Results: Based on t indices and interpretability, a 3-class solution for parental report and a 5-class solution for teachers report were optimal. For girls, again, a 3-class solution was the most appropriate for parents, and a 4-class solution for teachers. The parental latent classes included a non-symptomatic class, a severe combined class, a mild combined class for boys, and a mild impulsive-inattentive or combined class for girls. However, the teacher classes found were somewhat more elaborated and matching more or less with the parental classes. Conclusion: Our results promote the dimensional approach. The subgroups identied by behavioral ratings, could be accessible in further studies aiming to explore a more detailed cognitive neuropsychological prole of ADHD with subclinical variants. These distinct phenotypic groups are useful in diagnosis, treatment, neuroscientic and genetic research. Conclusion: The ADHD disorder founded in these children appeared in connection with some environmental factors, but a deeper investigation is needed for studying all these factors, in addition to others (psychological, socio-economical, and nutritional) ones.

P-22-07 Impact of the environmental factors on the Attention Decit Hyperactivity Disorder in Moroccan children F.-Z. Azzaoui*, H. Hami, A. Ahami * Kenitra, Morocco Objective: The objective of this study is to evaluate the Attention Decit Hyperactivity Disorder (ADHD) in urban, periurban and rural schooled children living in Gharb plain (North-West of Morocco), and to study the relationship between this neurobehavioral disorder (ADHD) and the quality of environment. This region is one of the most important agricultural and industrial regions of the Kingdom. Unfortunately, it suffered from the increase of different polluting human activities (metallic pollution) which expose the population, especially children to serious neurobehavioral problems. Method: The study was realized in 129 children, aged 6 to 8 years.Two questionnaires are used; one based on the DSMVI to evaluate ADHD and another about quality of the environment of children. Results: The obtained results had shown that the important percentage of ADHD was found in the rural school (33%) and that was signicant correlations between this disorder and the consumption of well water (p\0.05), the storing condition of water (p\0.01) and the PICA syndrome (p\0.05).

P-22-09 Neuropsychological proles of adolescents with childhood Attention Decit Hyperactivity Disorder F. Cuhadarolu, G. Evinc*, T. Cak, G. Dinc, Z. Tuzun, C. Esra * Ankara, Turkey Objective: The aim of this study is to examine the neuropsychological -namely, WISC-R (Wechsler Intelligence Scale for Children Revised) and Stroop- proles of adolescents diagnosed as ADHD in childhood. Method: 45 adolescents admitted to the Child and Adolescent Psychiatry outpatient clinic of a University Hospital and diagnosed as ADHD when they were 7-11 years of age and a group of 28 adolescents without ADHD at the same age range and interviewed in the

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175 same year were evaluated 6 years later and were compared. All participants were evaluated using Schedule for Affective Disorders and Schizophrenia for School Aged Children- Present and Lifetime Version (K-SADS-L), Wechsler Intelligence Scale for Children (WISC-R), and Stroop test. Results: In the study group 75.6% of the adolescents were still diagnosed as ADHD. WISC-R and Stroop results of adolescents having a continuing diagnosis of ADHD and control groups (adolescents who were remitted of ADHD and those who never had a diagnosis of ADHD) were signicantly different on coding and object assembly. Adolescents who had an ongoing ADHD had signicantly lower scores on two subscales of WISC-R, namely, digit span and object assembly., and had signicantly longer completion time and correction number on the fth card of STROOP test compared to the adolescents who exhibited remission at the second assessment and the ones who never had ADHD. Conclusion: This was one of the few studies investigating the ADHD children in adolescence and also the only study carrying this investigation on a multidimensional level. According to the results of this study it can be suggested that neuropsychological decits may be predictive for the ongoing ADHD diagnosis and they are helpful instruments for decision of the diagnosis and treatment however they can not be the only criterion.

Saturday, 28 May 2011, 14.3016.00 P-23 Diagnosis: Adults

P-23-01 Comorbidity, attachment and identity in adolescents with childhood Attention Decit Hyperactivity Disorder F. Cuhadaroglu Cetin*, H. T. Cak, G. Senses Dinc, Z. Tuzun, G. Evinc, E. Cop * Ankara, Turkey Objective: To examine the psychiatric status, attachment styles and identity in adolescents diagnosed as Attention Decit Hyperactivity Disorder (ADHD) in childhood. Method: This retrospective cohort study includes the reevaluation, 6 years after the diagnosis, of 45 adolescents between 13-17 years old with ADHD in comparison to 28 adolescents of the same ages with nonADHD psychiatric disorder. All participants were given K-SADSL, Sense of Identity Assessment Form and Relationship Scales Questionnaire. Results: The continuity of ADHD in adolescence was 75.6%. Comorbid psychiatric disorders were signicantly higher, the most common being anxiety disorders, oppositional deant disorder and conduct disorder. Comorbidity rate in the ADHD group was higher in adolescents with a RR of 3.3 (95% CI). Dismissing attachment pattern was relatively high in the ADHD group but a signicant difference regarding attachment styles or identity status was not found between the groups. Conclusion: Adolescents with ADHD are under greater risk for comorbidity compared to children with ADHD and the controls. There is no signicance of attachment styles or identity status. These ndings stress the high morbidity associated with ADHD in adolescents and support the importance of early recognition of this disorder for prevention and early intervention strategies in children with ADHD.

P-22-10 Comparison of behavior descriptions between ADD/ ADHD diagnosis and innovators using Kirtons AdaptionInnovation (KAI) theory C. Winton Brodeur*, C. Ritzen Kem * Gainesville, USA Objective: The purpose of this study is to look for an association between behaviors manifested and used to diagnose ADHD and behaviors manifested in Cognitive (problem solving) style using Kirtons Adaption-Innovation theory and the KAI Inventory Tool. Method: Compared the behaviors identied in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as published by the American Psychiatric Association (APA) and behaviors consistently manifested by different problem solving styles using Kirtons Adaption-Innovation Theory. Completed a pilot study on 100 formally diagnosed adult ADD/ADHD subjects. Used an online survey to identify participants formal diagnoses and additional variables including demographics, family history, and prescribed medications. Completed Kirtons Adaption-Innovation (KAI) Inventory on each participant to identify individual problem solving style. Completed the Myers Briggs Type Indicator (MBTI) focusing on Intuitive (N) and Perceiving (P) results for triangulation purposes with the KAI. Results: Statistical Analysis: A distribution comparison of the results with the general population (derived from several studies) will be provided along with the means and standard deviation to complete the data support of expectation. The case is especially strong as the KAI theory gives a very clear expected result with which results are clearly in accord. Narrative Results: Although general population usually falls in a normal bell curve for both KAI and MBTI results, the subjects in this study fell almost entirely on the innovator side of Kirtons Adaption-Innovation Continuum, and in the intuitive (N) and perceiving (P) side of the MBTI sixteen cell personality preference grid. The results of the pilot show that there is a strong correlation between those formally diagnosed with ADHD and Innovation. Behaviors identied by APA are closely aligned with behaviors manifested by innovators. Conclusion: Results support the need for a larger population study and increased training strategies based on KAI theory.

P-23-02 Are there differences between patients and close relatives evaluating retrospectively Attention Decit Hyperactivity Disorder (ADHD) psychopathology in childhood? A study using the short version of the Wender Utah Rating Scale (WURS-k) J. Buchli - Kammermann*, R.-D. Stieglitz * Basel, Switzerland Objective: ADHD persists in adulthood, and shows a prevalence of approximately 4%. To diagnose adult ADHD there needs to be a proven onset of symptoms in childhood. The German short version of WURS with 25 items provides valuable information to identify ADHD psychopathology during childhood retrospectively. ADHD should be recognised as a valid psychological disorder as it is, and the WURS-K plays an integral role in the complex diagnostic process. A cut-offscore above 30 in the WURS-k predicts a strong tendency for ADHD symptoms starting in childhood. However, only a very few studies have analysed the relationship between patient memories and those of close relatives concerning remembering the difculties the patients had during childhood. The aim of this study is to evaluate the symptom overlap, or differences between the two informants. Method: All patients passed through an ADHD diagnosis process consisting of clinical instruments by two psychologists from the adult ADHD consultation of the psychiatric outpatient department (University Hospital Basel). A sample of N=100 adults was evaluated with the following instruments: ratings scales (ADHD-SB, CAARS-R, -D; Rosler et al., 2008a) and a structured clinical interview: (WRI; Rosler

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176 et al., 2008a). Additionally, symptomatology in childhood was assessed with the WURS-k by the patients and close relatives. For both informants each of the 25 WURS-k items were analysed in terms of frequency. Results: First results show a symptom overlap between both informants for some of the 25 WURS-k items. There were certain groups of symptoms where differences were registered. Conclusion: We recommend using WURS-k especially for adult patients. Valuable input by close relatives could complete the ADHD diagnosis in adulthood, in case that WURS-k scores of the patient is below the cut-off-score. N=358), the Beschwerdeliste (B-L, N=155), the Fragen zur Lebenszufriedenheit (FLZ, N=155) and the General Depression Scale (ADS, N=155). Results: The results of the psychometric properties, the convergent validity and the discriminant validity will be presented on the congress.

P-23-05 Quality rather than quantity of symptomatic criteria for the diagnosis of adult ADHD I. Szpindel*, A. Turgay

P-23-03 A screening scale for adult Attention Decit Hyperactivity Disorder: Sensitivity, specicity and cut-off score data of Turkish form ASRS S. Dogan*, B. Oncu, G. Varol-Saracoglu * Tekirdag, Turkey Objective: Altough Attention Decit Hyperactivity Disorder (ADHD) has historically been known as a childhood disorder, it is currently recognised as a lifelong disorder in many cases and associated with severe morbidity and disability. Diagnosis of adult ADHD is clinically based and rests on a thorough clinical interview, in conjunction with results from symptom rating scales and supplemental information about the patients childhood from parents or siblings. These article presents sensitivity, specicity and cut-off score data of Turkish Form Adult ADHD Self-Report Scale (ASRS-v1.1) . Method: Sample of the adult ADHD group comprised of 30 patients at the Ankara University Psychiatry Department. Sample of the control group comprised of 282 undergraduates at the Namik Kemal University, Tekirdag. All participants completed the Turkish ASRS, and Structured Developmental History Questionnaire (SDHQ). Results: Turkish version of ASRS has a high level of sensitivity (73.3%) and specicity (92.3%). Additionally, our result showed that ASRS has 37 cut-off score. Conclusion: With this study, we found that ASRS is a higly sensitive and specicic enstrument. Its cut-of score is 37. ASRS screener is very helpfull in community surveys and primary care screening. Besides, it can be self-administered easily and quickly might make it a useful secondary measure to include in clinical studies.

* Toronto, Canada Objective: To calculate symptom frequencies in a sample of adult ADHD patients administered an additional validated general psychopathology screen at time of diagnosis, and to identify the most frequently occurring symptoms and compare them in frequency to those associated with DSM-IV and ICD-10 diagnostic criteria for adult ADHD. Method: A sample of 297 adults from Toronto diagnosed with ADHD by psychiatric evaluation, employing structured clinical interviews and validated, standardized rating scales, received additional assessment at time of diagnosis by Gadow-Sprafkin General Psychopathology Screening Scales. Averaged frequency percentages for each Gadow-Sprafkin symptom were calculated retrospectively and ordered. Symptoms corresponding to DSM-IV and ICD-10 diagnostic criteria for adults with ADHD were identied and compared in frequency to remaining symptoms. Results: The following were the most common symptoms, occurring in greater than 80% of cases and in descending order: Sense of underachievement 92.3%, intolerance of boredom 88.8%, multitasking 87.2%, distractibility 87%, difculty sustaining attention 86.5%, inability to reach potential 83.5%, time mismanagement 83.3%, impatience 83.3%, chronic procrastination 81%, search for high stimulation 80.8%, difculty organizing tasks 80.5%. These correspond to only four of the nine DSM-IV and ICD-10 ADHD inattentive criteria which instead includes these lower frequency symptoms from our sample: losing items 62%, forgetfulness 70.5%, inattention to detail 70.5%. Symptoms associated with impulsivity were observed in relatively low frequencies of 57.8%63.95%. Conclusion: Current DSM and ICD symptomatic criteria for the diagnosis of adult ADHD may be lacking in quality rather than in quantity. Rather than lowering the minimum symptom threshold for the adult diagnosis, a more suitable symptom list might more effectively be adopted. Moreover, the qualities of these symptoms suggest that impulsivity is overrepresented while executive dysfunction is underrepresented and may indicate which low frequency items derived from child presentations might best be substituted by which high frequency executive symptoms.

P-23-04 Psychometrics of the German short version of the Brown ADD scales C. Hauinger*, U. Ruhl, I. Hach * Gottingen, Germany Objective: The Brown Attention-Decit Disorder Scales are a widely used instrument for screening adult patients. This study sought to evaluate a German short form of the Brown-Attention-Decit Disorder Scales (BADDS-K). These scales are used in a screening and follow-up measurement of symptoms of Attention Decit Hyperactivity Disorder (ADHD) in an outpatient population. It is expected that psychometric properties will permit the usage of a short form in screening and follow-up measurement. Method: 987 patients from mixed settings, enrolled in an ongoing study were asked to complete the BADDS-K. 710 also completed the short version of the Wender Utah Rating Scale (WURS-K), 274 the Connors Adult ADHD Rating Scales (CAARS-S), 318 the Adult ADHD Self-Report Scale V1.1 (ASRS) and 202 the German selfrating behaviour questionnaire (ADHS-SB). For the mental health status they also completed the Symptom Checklist-90-R (SCL-90R,

P-23-06 Developing a South African self-report ADHD questionnaire A. Burke*, T.-L. Austin * Johannesburke, South Africa Objective: In a pilot study on the use of self-report questionnaires as an aid to identify and diagnose adult ADHD, it was found that current self-report questionnaires may not be reliable or valid for use in the South African context. In this study an attempt is made to design a more relevant self-report questionnaire.

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177 Method: In the pilot study 402 undergraduate Psychology students responded to an online survey in which they completed the Internal Restlessness Scale, Current Symptoms Scale, the Wender-Utah Rating Scale and the Adult ADHD Self-report Scale. An exploratory factor analysis was performed on the data to extract key symptoms that could be included in a self-report questionnaire. Results: The factor analysis yielded 7 factors. From this items were identied and included in a newly constructed questionnaire. The new questionnaire is similar to existing questionnaires as it covers items that retrospectively assess symptoms of childhood ADHD, and also covers items on current symptoms of ADHD. It differs from other questionnaires in that it includes a wider variety of symptoms, and is also structured in such a way that it covers behavioural, cognitive and emotional aspects of ADHD. Cronbachs alpha was calculated to determine the reliability of the Brief Symptoms scale, which was .933, which is satisfactory. Conclusion: As stated by McGough and Barkley (2004) there has been no scientic basis to support that the six out of nine symptoms, as required by the DSM-IV-TR, is applicable to adults. Furthermore, one of the frustrations with the DSM-IV classication of ADHD is that it does not quantify the intensity of symptoms, and leaves this problem up to the diagnostician to decide whether a symptom appears both frequently and seriously enough to warrant attention. In line with this argument Kent and Craddock (2003) comment on how much still remains to be learned regarding the development of symptoms into adulthood as some symptoms do appear to alter in their severity over time, for example hyperactivity. The scoring system in the questionnaire addresses both these issues as it allows for items to be scored both as the number of symptoms present, as well as the frequency of such symptoms. formal and informal discussions were found helpful by most participants. Conclusion: A training program for physicians to help them diagnose and treat adults with ADHD is feasible and effective. It requires didactic input, specialist mentorship and support and a combination of formal and informal case discussions and consultations.

P-23-08 Psychometric properties of the ASRS in a general population: ndings from the ChiP-ARD study H. Caci*, V. Oliveri, K. Dollet * Nice, France Objective: The mean worldwide prevalence of ADHD in the general population is estimated at 5.48% of school-aged children (about 800.000 individuals in France) and at 3.40% of adults (about 2 millions of individuals in France). Despite this, ADHD remains underdiagnosed in many countries. There are numerous reasons, among which we have identied the lack of validated scales. In France, clinicians and researchers cannot rely on normative data to interpret scale scores like the ASRS for adults. The ChiP-ARD study was designed to collect normative data in a random sample of pupils of the general population and their parents. Here we present the psychometric analyses of the Adult ADHD Self-Report Scale (ASRS). Method: Public schools were randomly selected in the city of Nice (south of France). The study addressed classes from last year of kindergarten (at least 5 years old) to last year of college. Teachers who agreed to participate in this study included up to 4 children: each of them was provided with a randomly drawn letter of the alphabet and selected children in the alphabetical order. Upon signed agreement of their parents, children were anonymously included in the study. Parents returned a booklet containing the ASRS. Results: 702 children were included and 844 booklets were returned by their parents (ratio = 1.20). Out of them, 784 ASRS were complete (92.89%). The total, inattention and hyperactivity scores are reliable (Cronbachs alpha = 0.85, 0.82 and 0.78, respectively) and independent of age and gender. With regard to the 6-item ASRS, 9 adults are screened positive for ADHD (1.15%). The structure of the ASRS was assessed by both exploratory factor analysis and conrmatory factor analysis (i.e. bi-factor model). Conclusion: The French version of the ASRS is a valid assessment of ADHD symptoms in adults. Norms can be derived with respect of age and gender. Study founded by the French Ministry of Health (Programme Hospitalier de Recherche Clinique 2009): ClinicalTrials.gov, record 09-APN-02.

P-23-07 Developing programs for physicians to diagnose and treat adults with ADHD J. Sadek*, L. Hechtman, L. Jerome, U. Jain, M. Weiss, D. Smith, A. Vincent * Halifax, Ns, Canada Objective: In 60% of children with ADHD, there will be continued impairment in adulthood. The National Co-morbidity Survey established the prevalence of ADHD in adults as 4.4%. It is likely that the demand for service will continue to rise. However, at this point, less than 12% of patients have been able to obtain services even at the primary care level. Therefore, a program for physicians to enable them to diagnose and treat ADHD across the lifespan is crucial Method: A program has been developed by CADDRA (Canadian ADHD Resource Alliance) through collaboration with 12 experts in the eld of ADHD. Forty-seven general physicians participated in the initial rounds of the program and provided feedback. The program focused on a small group, patient-centered interactive approach. The four session program (one month apart) consisted of didactic presentations, video clips, case presentations and a review of participants own cases. Didactic material included; epidemiology, etiology, diagnosis, differential diagnosis, co-morbidities, impairment and treatment. Twenty-four video clips on assessment, symptoms, impact, impairment, treatment, co-morbidities were reviewed at various points in the program. Expert assistance by phone was available to participants between sessions to enable them to actually diagnose and treat patients. Results: The majority of physicians who participated reported changes in their practice that translated into diagnosing more frequently, starting to treat patients with ADHD, referring less and following up their patients. Some physicians reported more condence in their ability to diagnose and evaluate co-morbidities. Real cases, interaction with the expert presenter and the combination of

P-23-09 Neural basis of decision making and reward: Disentangling euthymic patients with Bipolar disorder from adults with ADHD A. Ibanez*, A. Petroni, H. Urquina, M. Cetkovich, T. Torralva, F. Torrente, S. Baez, S. Strejilevich, M. Sigman, A. Lischinsky, F. Manes * Buenos Aires, Argentina Objective: Attention Decit Hyperactivity Disorder (ADHD) in adults, as well as the bipolar disorder (BD) share several DSM-IV criteria and present high rates of comorbidity.Both disorders present problems in everyday decision making. Nevertheless, previous decision making studies has shown inconsistent results. The goal of this work is to assess decision making with different tasks (behavioral as

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178 well neural correlates) of decision making in adult ADHD, BD a group of controls. Method: 13 ADHD patients, 13 BD patients and 25 controls (matched for age, sex and years of education), were assessed.We considered the Iowa gambling task (IGT), a modied version of a simple task of rational decision making under risk (RDMUR, Fernandez-Duque & Wifall, 2007; Judgment and Decision Making), and a rapid-decision gambling task (RDGT) witch elicit neurophysiological process (ERPs) involved in rapidly evaluation of motivational impact of events and in guiding choice behavior (Gehring, et al., 2002, Science). In order to assess the relation of decision making tasks and individual differences we include a multivariate analysis between ERPs and the groups neurocognitive prole. Results: No relevant differences on decision making assessed with neuropsychology (IGT and RDMUR) were observed between groups. Compared to controls, only last blocks of IGT (4 and 5) in BD group showed a tendency to select risky cards. Nevertheless, the RDGT assess with ERPs shown signicant differences. Feedback error related negativity (fERN) distinguished between monetary win and losses in control group. In ADHD and BD, fERN did not discriminate between win and loss. Consistently with those result, analysis of source location (Brainstorm) evidenced reduced responses of anterior cingulated cortex (ACC) to monetary reward/ punishment in ADHD and BD. Moreover, late neural processing related to reward magnitude (P3) was impaired in both, ADHD and BD. Important differences were observed between those disorders regarding neuropsychological prole and multivariate association to decision making results. ADHD showed a pattern of impaired reversal learning and non-exible responses to negative feedback. Those impairments were associated to clinical prole of impulsivity and hyperactivity. BD showed an abnormal sensitivity to feedback and an enhanced neural response to the magnitude of the reward (irrespective of the outcome -win or loss-). Those patterns were associated to memory performance and to psychopathological measures of depression and anxiety. Conclusion: Our data suggest that neurophysiological paradigms are well suitable for assessing objective measures of those everyday impairments of decision making in ADHD and BD. Finally, our results in ADHD and BD are discussed in the framework of models of reward processing and ACC. mothers of the ADHD group were found to have statistically signicant higher scores in all sub-scales compared with the control group (p \0.05). Results of the comparison of the fathers of both groups, all of the sub-scale scores of the fathers in the ADHD group, except the overall total sub-scale score of the sum of 3 subscale scores were found to be statistically higher than the control group (p\0.05). Conclusion: Higher rates of the symptoms of ADHD in parents of children with ADHD may indicate that these people experienced problems with themselves, partners and children, and in social life. For this reason, it will be useful for more effective progression of this process to take into account the evaluation of the parents for adulthood ADHD and related co-morbid psychiatric conditions during the evaluation and the treatment period of children.

P-23-11 Evolution of the CADDRA Canadian ADHD practice guidelines - user interface rationale U. Jain*, M. Weiss, L. Hechtman, D. Smith, D. Quinn, G. Farrelly, J. Sadek, A. Vincent * Toronto, Canada Objective: The Canadian ADHD Resource Alliance (CADDRA) was founded in 2005. One of its mandates was to create user-friendly, evidence-based, practice guidelines for clinicians working with ADHD across the lifespan. Since rst published ve years ago, the Canadian ADHD Practice Guidelines (CAP-Guidelines) have evolved over three editions. Method: The underlying objective was to provide every clinician with equal access to practice-based, evidence or consensus-based information in order to facilitate a competent and standardized assessment of ADHD in children, adolescents and adults. This required that the Guidelines were: a) accessible for free (including all the rating scales); b) downloadable; c) translated into both ofcial languages (English and French); d) user-friendly; e) comprehensive; and f) written so that the common practice issues of the clinician were addressed. Results: The CAP-Guidelines contain the most widely-used, freelyaccessible instruments of assessment and treatment for ADHD in Canada. The latest edition is available simultaneously on the CADDRA website (www.caddra.ca) and in print format in a binder to allow for new and updated material to be easily inserted over time. The newly-developed CADDRA ADHD Assessment Toolkit enables physicians to standardize the assessment and treatment process and is the cornerstone of CADDRA primary practitioner training programs. The CADDRA website is in the top ten of ADHD results, suggesting an international presence. Conclusion: The CAP-Guidelines are being translated into ve major languages and will have a global reach. What most distinguishes these Guidelines from others is their user-friendly interface, their online/ print strategy which allows for timely updates and revision, and their evidence-based approach. Clinicians want more than just information: they want to know it is reliable, practical and current. The CAPGuidelines provides all of the above.

P-23-10 The symptoms of Attention Decit Hyperactivity Disorder in the parents of the children with ADHD S. Simsek*, C. Gokcen, E. Fettahoglu * Antalya, Turkey Objective: Studies concerning ADHD have shown that this disorder has a high rate of familial transmission and its heritability rate varies between 55-92 percent. In this study, we aimed to investigate the features of ADHD seen in the parents of the children with ADHD. Method: Our study included parents of 34 children with ADHD aged between 6 and 17, for the control group, parents of 34 children aged 6-17 with no referral history to the Childrens Mental Health Clinic, with excluded diagnoses of ADHD and Disruptive Behavior Disorder (DBD) were enrolled in this study. To investigate whether the parents had the symptoms of ADHD, an Adult Attention Decit Hyperactivity Scale was given to parents of both groups. Results: There is no statistical difference (p[0.05) between age and the educational level of the parents in the patient and control groups. Results of the comparison of the sub-scale scores of the Adult Attention Decit Hyperactivity Scale showed that the

P-23-12 Criterion validity of an Attention Decit Hyperactivity Disorder (ADHD) screening list for screening ADHD in older adults E. Semeijn*, M. Michielsen, H. Comijs, A. Beekman, D. Deeg, S. Kooij * Amsterdam, The Netherlands

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179 Objective: To measure Attention Decit Hyperactivity Disorder (ADHD) in older adults, a screening instrument validated in the older population is needed. This study evaluates an ADHD screening list for adults, developed by Barkley on its usefulness in a populationbased sample of older adults. The predictive value of the ADHD screening list is investigated in the Dutch population. Method: Data were collected within the Longitudinal Aging Study Amsterdam (LASA). In a two-phase epidemiological design the criterion validity of the ADHD screening list was tested against a Dutch structured diagnostic interview based on the DSM-IV criteria (DIVA 2.0). At Phase 1, 1.494 older adults (61-95 years) were assessed with the ADHD screening list. In Phase 2, 234 older adults participated in the diagnostic interview. Sensitivity and specicity were determined using a ROC-curve with a cut-off score of 6 as suggested for adults by Barkley. Test-retest reliability was calculated using Spearmans rho. Results: With a cut-off score of 6, sensitivity and specicity were respectively 19.1% and 95.3%. Optimal sensitivity (61.9%) and specicity (74.2%) was reached with a cut-off score of 3 and an AUC of 75%. The test-retest correlation was 57%. Correlation between a positive screening on the ADHD screening list (cut-off C 6) and a DIVA diagnosis was 7%. Conclusion: Preliminary analysis on the data shows the ADHD screening list has limitations in its ability to adequately identify ADHD from non-ADHD in older adults in a population-based sample. P-24-03 Written production characteristics of children with Attention Decit Hyperactivity Disorder ` A. Mies*, E. Jurado, A. Fornieles, M. Quintana * Bellaterra, Spain Objective: This study analyses the text production abilities of students with ADHD and students without that disability, through evaluation of different aspects, such as planication, cohesion, causal conections and achievement of written text end, almong others. The purpose was to determine if there are any signicant differences between the study group and control group and between the different sub-types of ADHD. Method: Various studies show that stories by students with ADHD also make fewer references to the achievement of an end and include many causal connections between the ideas and unity of the text. (Soriano, 2008).Other authors emphasize that children with ADHD product shorter narrative and descriptive texts (Pedron and Cornoldy (2007) and have difculties in text categories, especially in coherence superstructures and syntactic cohesion (Gallardo, 2007). The sample involves 44 boys and girls between the ages of 8 and 10, 22 of them with ADHD and 22 in the control group. The participants go to state and public schools with State funding in the Metropolitan Area of Barcelona. All participants ` were assessed with TALEC (Test danalisi de lectura i escriptura ` en catala, Cervera, M. et al.) which includes various reading and writing sub-tests. Data process has been carried out using the SPSS-12.0 statistics kit. Pearson correlations, T-Test and ANOVA have been applied. Results: Main results show that the difference between the levels obtained between ADHD and Control groups is signicant (0.088), with higher scores for the control group. We also nd signicant differences in the majority of text evaluation categories. Conclusion: We conclude that there is evidence of the need to implement differential learning strategies and improvements in written texts by children affected by ADHD among the different subtypes and those who have learning difculties.

Saturday, 28 May 2011, 14.3016.00 P-24 Co-morbidity: Children and adolescents III
P-24-01 A clinical study of temperament, phenomenology and psychosocial factors in child and adolescents of disruptive behaviour disorders M. Bhatia*, V. Agarwal, P. Kumar, D. Verma * Delhi, India Objective: Children with disruptive behavioral disorders (DBD) have various factors behind their presentation such as temperament,intelligence & psychosocial factors.Systemic study of these factors is likely to delineate them as spectrum disorder or as a distinct entity. AIM-To clinically study phenomenology,temperament,psychosocial factors,comorbidity and parent handling style. Method: The study sample included patients aged 6 to 16 years in child and adolescent psychiatric OPD of CSMMU, Lucknow. All the patients were screened for ODD or CD & who screened positive were included in the study. TOOLS Semi structured Performa K-SADS-PL by Kaufman et al. Parent Interview schedule by W.H.O. Interview Schedule for Children by W.H.O. Temperament Measurement Schedule by Malhotra Parent Handling Questionnaire by Malhotra The following Statistical tools were used- Mean Standard Deviation t test for independent samples Chisquare test Fishers Exact Probability Test. Results: 69 patients, ODD (N=48) and CD (N=21),fullled the inclusion criteria.Mean IQ was 92.CD groups had statistically significant higher number of patients with presenting complaint of Indulges in ght (p\0.001).Lying, bullying and cruelty to animals were most commonly found symptoms in the CD group. ADHD was the most common co-morbidity diagnosis found in the both the groups. Conclusion: ODD and CD seem to be a spectrum disorder.

P-24-04 Performance evaluation of children with ADHD in reading/writing and math skills with Academic Performance Test - APT F. F. Dias*, M. C. Miranda, L. F. Coelho, S. Rizzutti, S. M. M. Palma, M. Muszkat, R. Fgaro, O. F. A. Bueno * Sao Paulo, Brazil Objective: Attention Decit Hyperactivity Disorder is considered an important educational, social and health problem. It is characterized by motor, perceptual, cognitive and behavioral disturbances that impair a childs learning, including neuropsychiatric disorders, which result in compromised quality of life. The aim of this study was to evaluate, in children with ADHD, the results of the Academic Performance Test (APT). Method: We evaluated 25 children and adolescents aged 6 to 12 years diagnosed with ADHD, who were submited to several clinical and neuropsychological assessments to determine: level of intelligence, diagnosis, Attention Decit Disorder, neuropsychologica l prole (memory, attention, executive functions and visual spatial abilities) and achievement in reading, writing and math. The APT is a psychometric instrument that aims to offer an objective evaluation of core capacities for academic performance.

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180 Results: Learning difculties, studied here, most of them were in writing and reading, where the performance of children in general was below the average for the level of education in which they were. Conclusion: Due to the number of children with ADHD identied with learning difculties, believed to be necessary evidence, to be held in schools, projects for dissemination and intervention to help children with difculties in school subjects. Only then can we help to reduce the school failure of these children. Since both the literature as empirical data, such as those presented in this paper show how the coexistence of this disorder can affect the quality of life of children, it is believed that the benets would not only improve their skills in school, as also, the quality of life. specically investigates the relationship between home environment and reported sleep disturbances Method: The study was conducted at the Child Psychiatry Unit, All India Institute of Medical Sciences, New Delhi, India. Twenty clinically referred children (aged 6-11, and medication naive) were assessed for ADHD using Conners Parent/Teacher Rating Scale, and Conners Global Index-Parent version. The children underwent subjective assessment of sleep disturbances using Pediatric Sleep Questionnaire, Child Sleep Habits Questionnaire, Epsworth Sleepiness scale, Screening Questionnaires for Restless Leg Syndrome and Obstructive Sleep Apnea. Sleep parameters assessed were bedtime resistance, sleep onset difculties, night awakenings, restless sleep, sleep duration, difculty in morning awakening, excessive daytime sleepiness, parasomnias and sleep disordered breathing. A semi structured interview was conducted to elicit home environment and sleeping arrangement for the child. Results: In India children usually sleep in parents bedroom and are awake participating in late night activities which include watching TV and socializing. Parents reported that they observed bedtime resistance in their children. 30% of children with ADHD had enuresis and would talk during sleep. 5% had night terrors and 10% had seizures. Family members found it difcult to cope up with the sleep difculties of the child Conclusion: In India family environment and sleeping arrangement contributes to sleep resistance, and difculty in morning awakening. About 5-30% of children were found to have sleep disturbances.

P-24-05 Differences in brain dynamics of ADHD children with and without comorbidity of learning disability P. Adibpour*, S. Farahibozorg, N. Sadoughi, R. Rostami, M. Ahmadlou * Tehran, Iran Objective: Since ADHD is highly probable to co-occur with Learning Disability (LD), differential diagnosis of the two conditions seems to be crucial both for accurate pathology assessment and selection of effective treatment. The aim of the present study is to explore whether nonlinear dynamic analysis of brain through EEG can be used to differentiate ADHD children from those with LD comorbidity. EEG dimensional complexity is a representative of brain functioning complexity which is related to the number of independent variables needed to describe the dynamics of brain and central nervous system. Therefore in this study, EEG dimensional complexity is used to show differences of brain dynamics between ADHD children and those with LD comorbidity. Method: The subject group consisted of 31 ADHD children (mean age=8.671.49 years) and 29 sex matched with LD comorbidity (mean age=9.171.77 years). The EEG signals were recorded using 19 channels, according to 10-20 international protocol, for 4 min with sampling rate of 256 Hz during eye-closed resting condition. Correlation Dimension (CD) was computed, using Grassberger-Procaccia algorithm, to quantify dimensional complexity of EEGs. Averaging CDs of all EEG channels located in each brain region (frontal, right and left lateral, parieto-occipital, and central) resulted in CD of that region. Statistical evaluation of results was performed using one-way ANOVA in regional scale, nding out how different the two groups are. Results: The primary difference was found in frontal area (p-value 0.0047) followed by meaningful differences in left and right lateral and parieto-occipital areas (p-values: 0.018, 0.029, and 0.049, respectively). ADHD group showed higher complexity both regionally and overall brain. Conclusion: Reduced dimensional complexity of EEGs in the comorbid group compared to ADHDs could be attributed to more decient synchronization and activity of the brain networks involved in learning in the comorbid patients.

P-24-08 Comorbid autism and ADHD: Parent stress and coping D. Hamilton*, J. Whelan * Fitzroy, Australia Objective: The study aimed to: examine the prevalence of comorbid ADHD in children with autism spectrum disorder (ASD); determine the effect of comorbid ADHD on self-reported depression, anxiety and stress in parents of children with ASD; and examine possible between-group differences in coping strategies adopted by parents in stressful situations. Method: 171 parents of children with autism completed an online questionnaire which included the 21-item Depression, Anxiety, Stress Scale (DASS; Lovibond & Lovibond, 1995) and two sets of 16 items taken from The Cope (Carver, Scheier and Weintraub, 1989), a measure of coping strategies adopted in stressful situations, each set preceded by a description of either a changeable or unchangeable situation involving an autistic child. Results: 39 children (22.8%) had a comorbid diagnosis of ADHD. The age difference between children with and without ADHD was not signicant (t=1.40, p=.16). Presence of ADHD did not predict levels of parental depression, anxiety, or stress. Parents with or without a child with ADHD did not differ in their use of coping strategies (all p[.05). Many parents in both groups were found to be severely depressed, and the majority were also found to have severe anxiety. Higher levels of depression predicted low use of emotion-focused coping in a changeable situation as well as lower levels of problemfocused coping in both types of situations. Anxiety also predicted higher levels of both styles of coping. Parents higher in depression were less likely to use to either coping strategies in dealing with stress, while parents higher in anxiety were more likely to use both coping styles. Conclusion: Previous ndings on the prevalence of comorbid ADHD in autistic children were supported.The presence of ADHD does not increase parental psychological distress, nor does it affect the use of coping strategies. Coping strategy use was related to levels of anxiety and depression.

P-24-06 Sleep disturbances in children with Attention Decit Hyperactivity Disorder A. A. Joseph*, M. Mehta, R. Sagar, G. Shukla * New Delhi, India Objective: The present study aims to examine sleep disturbances in children with Attention Decit Hyperactivity Disorder (ADHD). It

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Saturday, 28 May 2011, 14.3016.00 P-25 Co-morbidity: Adults II

P-25-01 ADHD and axis I disorders

persistence of ADHD symptoms into adulthood. In the present study, we systematically analyzed comorbid anxiety and depression in a sample of adult ADHD outpatients in order to estimate the incidence of these disorders in an undiagnosed patient population.

P-25-03 ADHD and axis II disorders U. Ruhl*, C. Hauinger, I. Hach * Gottingen, Germany Objective: Already in Childhood, comorbidities between AD(H)D and axis I disorders exist, e.g. social behaviour disorders. In terms of epidemiology as well as in developmental psychopathology the question comes up, if and which of the comorbid disorders continue to exist in adulthood. As a consequence, the question arises, if AD(H)D exists in adulthood or if the symptomatic can be explained by other mental disorders. This subject matter, that is also important for the treatment strategies, is not yet sufciently researched by empirical studies. Method: Since 2005, a standardized diagnostic (DIA-X, questionnaires to different mental health disorders) takes place at the beginning of a therapy in the Therapy- and Counselling Centre of the University of Goettingen. Within this process, patients ll out a screening for Attention Decit Hyperactivity Disorder (ADHD-SB, Rosler et al.). Patients who were screened positive will be invited to an ADHD-specic diagnostic where they complete performance tests (FAKT, WCST, WIT) and ADHD-specic questionnaires (BADDSK, WURS-K, CAARS). Results: 580 patients took part in the standardized diagnostic. Thereof 212 patients took part in the ADHD-specic diagnostic.First analyses show that there is a high comorbidity between ADHD and major depression or anxiety. Conclusion: Further results will be presented on the congress. I. Hach*, C. Hauinger, U. Ruhl * Nurnberg, Germany Objective: Results of studies in childhood show that patients with ADHD feature a higher risk for developing a personality disorder. During childhood, the question of the differential diagnoses between ADHD and personality disorder is marginal. In adulthood on the opposite, this question gets a higher importance. E.g. the emotional instability is on the one hand part of the ADHD and on the other hand of the borderline personality disorder. Method: Since 2005, a standardized diagnostic (DIA-X, questionnaires to different mental health disorders) takes place at the beginning of a therapy in the Therapy- and Counselling Centre of the University of Goettingen. Within this process, patients ll out a screening for Attention Decit Hyperactivity Disorder (ADHD-SB, Rosler et al.). Patients who were screened positive will be invited to an ADHD-specic diagnostic where they complete performance tests (FAKT, WCST, WIT), ADHD-specic questionnaires (BADDS-K, WURS-K, CAARS) and the structured clinical interview for personality disorders (SCID-II). Results: 580 patients took part in the standardized diagnostic. Thereof 212 patients took part in the ADHD-specic diagnostic. Conclusion: Results will be presented on the congress.

P-25-02 Comorbid mood and anxiety disorders in adult ADHD patients D. Meshkat*, A. Kutzelnigg, C. Eckert, A. Konstantinidis, S. Kasper * Vienna, Austria Objective: ADHD is a highly heritable neurodevelopmental syndrome with signicant lifetime risk for psychiatric comorbidities. Several psychiatric conditions are signicantly more common in patients with ADHD than in control subjects. Method: To evaluate the incidence of comorbid affective disorders, patients with adult ADHD who were rst seen at the outpatient clinic of the Department of Psychiatry and Psychotherapy were evaluated for symptoms of major depression, brief recurrent depression, bipolar depression and anxiety disorders. Patients aged between 18 and 75 years were included into the study. Both ADHD symptoms and symptoms of comorbid psychiatric conditions were evaluated according to DSM IV TR criteria. So far, from February 2007 until December 2010, 383 patients (224 males and 159 females) were included into the study. Results: The mean age of the patients at diagnosis was 33,3 years for males (range: 18-75) and 35,8 years for females (range: 18-64). Affective disorders were most frequently diagnosed as current comorbid conditions in our patients and occurred in 37% of the patients in our sample. Of these, 17% had minor depressive episodes, 14% had major depressive episodes and 6% were diagnosed with bipolar disorder. 21% of our patients were diagnosed with one or several comorbid anxiety disorders. Conclusion: Most adults with ADHD are not diagnosed properly and therefore remain untreated although they are usually diagnosed and treated for comorbid psychiatric disorders. Furthermore, the presence of psychiatric comorbidities may be one factor that inuences the

P-25-04 The accompaniment of inattention with daily excessive sleepiness among individuals with attention decit disorder or Attention Decit Hyperactivity Disorder S. Shirataki*, S. Moriyasu, Y. Idehara * Kobe, Japan Objective: To investigate the appropriateness of hypothesis on the developmental milstones in attention function; reexive attention, alerting attention, orienting attention, and executive attention. But, the reexive attention is at moment a focus of discussion. The authors hypothesis is that the reexive attention has certainly a pivotal role in the early infants in whom attention is possible only in the state of wakefulness and impossible when this wakefulness is changed into sleep state. Therefore, we may expect one type of inattention in affected children or adults can be caused by the distorted neurophysiological system which concern with sleep and wakefulness alteration or maintenance of wakefulness state. Method: Using detailed symptoms analysis, the ADHD RS-IV Japanese Version, and Continuous Performance Test for randomly chosen patients with inattention, all subjects were diagnosed with Attention Decit Disorder (ADD) for 5 adults individuals (age range from 20 to 42 yrs) and Attention Decit Hyperactivity Disorder (ADHD) for 5 children (age range from 12 to 14 yrs). Furthermore, all these individuals were found to be affected by the daily excessive sleepiness. The routine EEG recordings were undertaken to investigate whether subjective sleepiness in these individuals can be objectively conrmed or not in EEG by the presence of slow wave sleep activities. Results: It was conrmed that all adults individuals with ADD and all children with ADHD are accompanied by daily excessive sleepiness, and also conrmed that this sleepiness is not a subjective feeling, but, it was objectively demonstrated by the dominant slow wave sleep

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182 activities in the EEG recordings which were undertaken at around 10 am in the morning. Conclusion: High frequency accompaniment of inattention with daily excessive sleepiness among individuals with ADD or ADHD can be understood easily when we take into account that the rst attentional milestone is grounded on the Brainstem Activating Reticular System which closely related with the sleep and wakefulness alterations or wakefulness maintenance. Method: To assess the existing scientic literature the medical and psychological databases such as PsychInfo and Medline were searched. Using Google the combination of ADHD and Sports addiction was assessed. Several experts in sport psychology and psychiatry were interviewed. Results: There are some rare case reports and only one open study on ADHD and sports addiction. In the open eld of the Internet there exist several self help groups and chat communities on the topic. The experts consider sports addiction as a possible explanation for massive hyperactive behaviour of individuals and postulate more systematic research. Conclusion: Addictive behaviour in Sports should be considered as a possible comorbid behavioural pattern in ADHD-patients with massive hypermotoric symptoms and a possible explanation for lack of treatment success. On the other hand, systematic research could distinguish between the numerous protective aspects of sports for ADHD-patients and the possible risc for some vulnerable individuals.

P-25-05 Sleep in adults with Attention Decit Hyperactivity Disorder (ADHD) of the predominantly inattentive (ADHD-I) and combined (ADHD-C) subtypes R. Yoon*, U. Jain, C. Shapiro * Toronto, Canada Objective: To determine the nature and frequency of sleep disturbances in adults with Attention Decit Hyperactivity Disorder (ADHD) Method: This is an observational study of sleep in ADHD patients, using questionnaires designed to assess daytime sleepiness, sleep quality, alertness, circadian preference, and fatigue. Results: Approximately 90% of patients with ADHD report either excessive daytime sleepiness or poor sleep quality, suggesting that a very large percentage of patients with ADHD suffer from sleep disturbances. Because we wanted to determine whether daytime sleepiness is attributed to poor sleep quality, we assessed correlations between daytime sleepiness and sleep quality. While there is no correlation between daytime sleepiness and sleep quality, there is a correlation between sleep quality and fatigue. This suggests that quality of sleep does not necessarily result in daytime sleepiness but, rather, gives rise to the experience of fatigue. This is important from a clinical perspective, because it implies that fatigue, rather than daytime sleepiness, is a marker of sleep disturbances. It also raises questions about the experience of sleepiness: if sleepiness is not associated with sleep quality, is sleepiness a pathological condition rather than a symptom of sleep disturbances? It is important to note that although the ndings of the subjective data are interesting, studies in childhood ADHD have revealed that subjective data do not necessarily correlate with objective data. As a result, even though about 90% of ADHD patients are found to suffer from signicant daytime sleepiness or poor sleep quality, such ndings may not coincide with data collected through objective methods such as polysomnography (PSG), a diagnostic tool used to collect objective sleep data. We are currently collecting sleep data with PSGs to objectively assess sleep disturbances in ADHD. Conclusion: Given the high incidence of sleep problems in ADHD, we believe that understanding sleep in ADHD will lead to better understanding of the complexities of ADHD and, consequently, to the development of alternative and effective treatment options.

P-25-07 Personality traits in a small sample of adults with ADHD: Evaluation with temperament and character inventory, revised (TCI-r) and the NEO-Personality Inventory, revised (NEO-PI-R) C. S. Miguel*, M. Klein, M. A. Gobbo, M. A. Silva, L. C. Monteiro, T. M. Alves, M. Louza * Sao Paulo, Brazil Objective: To evaluate personality traits of adults with ADHD using the Brazilian versions of the Temperament and Character Inventory-revised (TCI-r) (Cloninger and Goncalves 2010) and the NEO Personality Inventory, revised (NEO-PI-R) (Costa and McCrae 2007). Method: Six adult subjects (4 men, age: 41.5 14.5 years) with ADHD (according to DSM-IV criteria) fullled both the NEO-PI-R and the TCI-r in two different occasions to avoid fatigue. All had at least 10 years of formal education. They did not fulll criteria for personality disorders. Means and standard-deviations (absolute scores) of the 5 main factors of the NEO-PI-R and the 7 main scores of the TCI-r were compared with normative Brazilian data using onesample T-test from SPSS version 14. Results: Persistence (a Temperament dimension) and Self-Directedness (a Character dimension) of the TCI-r were signicantly lower than the population mean. In the NEO-PI-R, Neuroticism was signicantly higher than the normative data and Concientiousness was signicantly lower than the population mean value. Conclusion: Both in the TCI-r and the NEO-PI-R differences in dimensions were observed in comparison with the normal population. These dimensions describe some of the clinical characteristics, symptoms and functioning of ADHD patients. References: Costa PT, MacCrae R. NEO PI-R: Inventario de Personalidade Neo revisado e Inventario de cinco Fatores Neo Revisado NEO-FFI-R (versao curta). 1st Ed. Sao Paulo: Vetor, 2007. Goncalves DM, Cloninger CR. J Affect Disord. 2010;124(1-2):126-33.

P-25-06 Sports and movement addiction in adolescents with ADHD - is this an existing differential diagnosis? Review of the literature in sports psychiatry O. Bilke-Hentsch*, M. Schmelzle * Berlin, Germany Objective: Sports Psychiatry is an emerging eld both in clinical and public interest. Scientic literature is sparse and hitherto concentrates on psychiatric disorders of athletes such as anorexia in runners and gymnastics or use of illegal substances in doping. In the context of severe motoric hyperactivity in ADHD-patients there may be clinical reason to see movement or sports addiction as a concept to explain specic features.

P-25-08 Emotional empathy and suicidal ideation in adult ADHD E. Gleichgerrcht*, F. Torrente, T. Torralva, F. Manes, A. Lischinsky * Buenos Aires, Argentina Objective: To determine the relationship between emotional empathy and suicidal ideation in adults with Attention Decit Hyperactivity Disorder (ADHD) Method: Forty patients diagnosed with ADHD were grouped according to whether or not they reported suicidal ideation (SI) on the corresponding item of the Beck Depression Inventory. Empathy was

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183 assessed with the Interpersonal Reactivity Scale (IRI), including emotional empathy (empathic concern and personal distress subdomains) and cognitive empathy (perspective taking). Patients and their closest relatives also completed questionnaires on aggressive behavior, depression, anxiety, impulsivity, and quality of life, among others. Results: Compared to patients reporting no SI (no-SI-ADHD, n = 23), ADHD patients who reported SI (SI-ADHD, n = 17) exhibited signicantly increased levels of personal distress (U = 96.0, p \ .01) in the absence of signicant differences on empathic concern (p = .32) or perspective taking (p = .94). SI-ADHD patients also exhibited signicantly higher scores on childhood inattention (p = .03), depression as perceived by relatives (p = .025) and by themselves (p\ .001), apathy (p = .02), and anxiety (p = .012 for state, .019 for traits). Quality of Life was signicantly reduced in SI-ADHD (p = .05), with particularly low scores on global impression of life quality (p \ .01). In fact, personal distress, but not empathic concern, correlated signicantly with quality of life. Conclusion: Adult ADHD patients who exhibit suicidal ideation may have decits in the regulation of emotional empathy, leading to increased personal distress. This, in turn, seems to be associated with a poorer quality of life, accompanied by a wide array of psychiatric symptoms. Measuring different aspects of emotional empathy in ADHD patients can provide insight into the emotion regulation disturbances that characterize this population. Regression). Hyperactivity/Impulsivity could be correctly classied by differences in speech-rhythm: in the free-speech-task with 76.8% and 79.2% in the counting-task (log. Regression). The analysis of the voice quality correctly classied 65.1% of the subjects in the free speech task and 76.2% with the vowel/a/(log. Regression). Conclusion: These results indicate strong evidence for the possibility of an objective measurement of inattention and hyperactivity via the voice analysis of certain acoustical properties in the speech of ADHD-patients. In the near future we aim to 1. Verify our results on a larger sample. 2. Differentiate the ADHD-voice parameters from other Axis-1 disorders. 3. Finally we will investigate ADHD-subjects with comorbidities in order to differentiate ADHD-markers and those of comorbidities intra-individually.

P-26-02 Can quantitative EEG (QEEG) measures be used as objective indices in the diagnosis of Attention Decit Hyperactivity Disorder (ADHD) in adults? Preliminary study in a Hungarian clinical sample of adults with ADHD V. Simon*, P. Czobor, L. Tombor, S. Papp, S. Komlosi, B. Kakuszi, B. Szuromi, L. Balogh, A. Angyalosi, D. Kovacs, I. Bitter * Budapest, Hungary Objective: The diagnosis of ADHD lacks objective measurement tools and indices. A growing body of literature suggests that children with ADHD show an increase in EEG spectral power in the low frequency bands compared to healthy controls. However, there is a relative lack of such quantitative EEG (QEEG) data in adults with ADHD. Objective of this study was to investigate the association between symptoms of ADHD and power spectral indices of the QEEG in adults with ADHD; further, to test whether adults with ADHD are distinguishable from healthy controls along these QEEG measures, including absolute power and cordance. Method: Thirty adults with the DSM-IV diagnosis of ADHD and 30 matched control subjects were included in the study. Resting state, high-density EEGs were recorded using the BioSemi System (BioSemi, the Netherlands) from a 128 channel scalp montage, band-pass ltered (between 0.05 and 70 Hz), and digitized at 1024 Hz. Epochs with blinks and eye movements were rejected ofine. Absolute and relative power was calculated from epochs of 2500 ms duration for the major EEG frequency bands including delta, theta, alpha and beta, respectively. Cordance was computed according to a three-step algorithm including (a) the computation of re-attributed power, (b) normalization across electrode sites; and (c) summation of the z-scores for absolute and relative power. ADHD symptoms were evaluated based on the Conners Adult ADHD Rating Scale (CAARS) subscales scores for the analysis. Results: Preliminary results of this study indicate a signicant (p\0.05) association between symptoms of ADHD, as measured by the CAARS subscale scores, and absolute power, as well as a signicant (p\0.05) difference between the ADHD and control groups in absolute power and cordance. Conclusion: Preliminary ndings of this study suggest that QEEG may be used to differentiate adults with ADHD from healthy control subjects.

Saturday, 28 May 2011, 14.3016.00 P-26 Biomarker candidates

P-26-01 The voice of ADHD - vocal acoustic biomarkers in ADHD D. Langner*, J. Langner, L. Gentschow, P. Kunze, E. Ahlers, M. Colla * Berlin, Germany Objective: The study aims to detect vocal acoustic biomarkers for the main symptoms of ADHD, inattention and hyperactivity/impulsivity, based on the analysis of acoustical properties in the speech of adult patients with ADHD. This study is part of the ADHD Voice-Analysis project, granted by the German Federal Ministry of Economics and Technology (ZIM-KF2247401AK9). Method: We analyzed the high quality recordings from 161 subjects. The sample consisted of 77 adults drug-naive patients diagnosed with ADHD and no comorbidities (subtypes: inattentive =34, combined =37, hyperactive = 6) and 84 healthy controls. Each participant was voice-recorded for about ve minutes with a headset microphone. The participants were asked to a) speak freely three minutes and report on any chosen, emotionally neutral, topic, b) count from 1-10, c) read a given phrase, d) produce different vowels and consonants. We analyzed the voice quality and the speech rhythm. The speech rhythm was analyzed with rhythm-oscillograms, a new method of analysing periodicities as fundamental aspects of speech-rhythm (J. Langner, 2002). The voice quality was analyzed via subtle timbre-analysis, originally developed for the music-analysis, and now also in operation of speech-analysis, patented by J. Langner in 2003. Results: The analysis of the voice quality showed signicant results for both symptoms, inattention and hyperactivity/impulsivity. Inattention was correctly classied with speech-rhythm: in the freespeech-task with 73.6% and 72.0% accuracy in the counting-task (log. Regression). The sound-analysis of the voice quality performed even better detecting the subjects: in the free-speech-task with 71.5% correct classication and 79.9% using the sound of the vowel/a/(log.

P-26-03 An electroencephalographic biomarker separated patients with Attention Decit Hyperactivity Disorder into two subgroups with signicantly different clinical proles S. Snyder*, T. Rugino, M. Hornig, B. Daviss, E. Tsai, T. Lock, G. Marsella, R. Davis, R. Scheffer, R. Williams, K. McBurnett * Boulder, Colorado, USA

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184 Objective: Methods are needed to support clinical integration of potential biomarkers for Attention Decit Hyperactivity Disorder (ADHD) in a manner that augments the clinicians evaluation. We investigated the use of an electroencephalographic (EEG) biomarker to separate patients with ADHD into two test-result subgroups, and we assessed clinical utility by evaluating these subgroups for clinically meaningful differences. Method: Investigators conducted a multi-site, double-blinded, clinical cohort study. Recruits were 364 children and adolescents, ages 6.0017.99 years, consecutively presenting with attentional and behavioral concerns to 13 clinical sites in geographically distinct regions of the US. ADHD was determined prospectively by a best estimate diagnosis requiring reviews of comprehensive clinical data sets by 3 independent diagnosticians. An EEG biomarker collected under double-blinded conditions was used to separate patients with ADHD into 2 test-result subgroups: 1) EEG-positive (standardized theta/beta ratio greater than a predened cutoff); n=101, and 2) EEG-negative; n=89. Results: As compared with the EEG-positive subgroup, the EEGnegative ADHD subjects were signicantly more likely to have the following clinical features: psychiatric disorders that could lead to ADHD exclusion (odds ratio, OR=2.0), medical or neurological conditions known to mimic ADHD (OR=9.5), uncorrected vision or hearing problems (OR=2.3), history of no improvement (OR=8.5) or adverse events (OR=3.9) on ADHD medications, presentation with a primary concern of aggression (OR=2.0) or anger (OR=4.1), satisfactory academic and intellectual performance (OR=4.1), and evidence of dissatisfaction with ADHD diagnosis (OR=7.7). Conclusion: EEG test-result subgroups of ADHD patients had signicantly different clinical proles with potential impact on ADHD diagnosis and management. The EEG-negative subgroup was more likely to have complicating conditions that may require further evaluation before clinicians should accept ADHD as the primary diagnosis. p= 0.00. In our study, stop-signal delay (SSD) was set as variable and dependent on subjects performance. A signicant SSD difference between the unaffected 4q13.2 and controls was found, t(65)= 2.50, p= 0.02), characterized by a larger SSD in the 4q13.2 group. Conclusion: Locus 4q13.2 might be acting as a protective factor in ADHD-unaffected family members, enhancing their inhibitory control as exhibited with the electrophysiological marker N200. Our ndings suggest the need for further analyses to evaluate the feasibility of using inhibitory control as an endophenotype in this particular ADHD isolate.

P-26-05 Investigation of brainstem dysfunction in ADHD - ABR changes and medication effects S. Nielzen*, J. Kallstrand * Lund, Sweden Objective: To assess brainstem integrative mechanisms by means of Auditory Brainstem Response (ABR) in medicated and unmedicated adult patients with ADHD. Method: Thirty unmedicated and 16 medicated patients with ADHD were compared with 72 healthy subjects with respect to their brainstem responses to complex sound stimulation. Data were analyzed by means of multivariate statistics. Results: Signicant aberrations were found in unmedicated patients predominantly at the levels of pons and thalamus. Medicated patients showed the same tendencies but the deviations were substantially reduced. Conclusion: Subcortical networks are affected in ADHD. Furthermore, the ABR technique is well suited for assessment of such deviances and the possibility of controlling medication is opened by this method.

P-26-04 Examining the feasibility of N200 as an endophenotype candidate in a genetic isolate of familiar type ADHD N. Trujillo-Orrego*, M. A. Garcia-Barrera, C. B. Holroyd, D. A. Pineda * Victoria, Canada Objective: An unanswered question in ADHD research regards the relationships between genetic variations and behavior, possibly addressed with the examination of endophenotypes. N200 is a robust electrophysiological marker for inhibitory control. This study examined N200 as an endophenotype candidate for inhibitory control in familiar type ADHD. Method: The sample was selected from an ADHD family study previously conducted in Antioquia (Arcos-Burgos et al. 2004). Linkage analyses identied 31 affected and unaffected subjects for this study, grouped into 4 subsamples: affected/unaffected and linkage loci 4q13.2/11p15.5. A sample of 59 subjects conformed our control group. Inhibitory control was examined using Stop-Signal Task (SST), and brain-electrical activity was recorded. N200 peak amplitudes in success and fail no-go trials were then calculated and examined within the region of interest. A mixed-design repeated measures ANOVA was used to examine statistical differences between groups. Results: We found an interaction effect for successful and fail conditions between unaffected 4q13.2 and controls, F(1, 64)= 4.50, p= 0.04. No other interactions were found. Post-hoc analyses showed that peak of amplitude for the N200 varied according to accuracy; specically, a signicant reversed pattern was found, characterized by larger N200 amplitude for success trials in controls, and a lesser amplitude in the 4q13.2, despite similar accuracy rates, t(66)= 3.59,

P-26-06 Alterations in the function of hypothalamic-pituitarythyroid axis in children with psychiatric disorders M. Dabkowska* * Bydgoszcz, Poland Objective: Thyroid abnormalities have been associated with Attention Decit Hyperactivity Disorder (ADHD) and with other childhood psychiatric disorders. Some type of thyroid dysregulation can contribute to ADHD. Attention decit disorders are a frequent manifestation of resistance to thyroid hormone (RTH). Resistance to thyroid hormone is caused by mutations in the hormone-binding domain of the human thyroid hormone receptor b gene. Resistance to thyroid hormone was associated with impaired function in the parts of the brain that are active in paying attention to and processing what we are trying to listen to. Other parts of the brain went into hyperactivity in an attempt to compensate. The goal of this study was to determine the relationships between thyroid hormone concentrations and psychiatric diagnosis in children, especially with ADHD. Serum TSH measurement is the most diagnostically sensitive test for detecting mild (subclinical), as well as overt, primary hypo-or hyperthyroidism in ambulatory patients. Serum TSH, fT3, fT4 was determined in 42 patients (30% girls, 70% boys), mean age 14 years, diagnosed with ADHD, anxiety disorders, psychoses and ODD. Method: We examined 42 children referred to a clinic ambulatory for different psychiatric problems, measuring their thyroid stimulating hormone (TSH), fT3, fT4 levels and correlating them with diagnostic and descriptive information. The function of hypothalamic-pituitarythyroid axis was measured by means of the Architect TSH (Abbott Laboratories) chemiluminescent microparticle enzyme

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185 immunoassay (CMIA) for the quantitative determination of serum TSH, fT3, fT4. Results: In 30% children was noticed alterations in the function of hypothalamic-pituitary-thyroid axis, the half of this group had abnormalities in level of fT3. The data showed that it was the more subtle functional abnormalities rather than gross pathologic ones. Conclusion: Selective screening for thyroid dysfunction of children with psychiatric disorders, especially Attention Decit Hyperactivity Disorder appears to be justied. Method: Color (C), form (F) and color-form (CF) naming were administered to 32 ADHD adults pre- and post-treatment and 32 controls. Results: Cognitive speed (F2, 90 = 71.95; p = .000000) and processing efciency (F2, 90 = 42.77; p = 0.000000) differed signicantly between ADHD adults pre- and post-medication and controls. Cognitive-speed and processing-efciency were signicantly reduced in ADHD adults pre-medication (M = 69.31 and 13.81 s.) compared to controls (M = 47.63 and 3.56 s.) and in ADHD adults pre-medication (M = 69.31 and 13.81 s.) compared to postmedication (M = 46.25 and 3.16 s.). These measures did not differ between ADHD adults post-medication and controls. Applying failcriteria for cognitive-speed ([60 s.) yielded 75% sensitivity and 100% specicity and for processing efciency ([?6 s.) 88% sensitivity and 81% specicity. Combining fail-criteria yielded 94% sensitivity and 84% specicity. Conclusion: Preliminary ndings suggest that AQT cognitive-speed and processing-efciency measures may be used to screen adolescents/adults for ADHD.

P-26-07 The objective measurement of the activity in Attention Decit Hyperactivity Disorder children M. Dabkowska*, T. Pracki, D. Pracka * Bydgoszcz, Poland Objective: Motor hyperactivity is one of the core symptoms in ADHD. These children have serious problems with the control of their moves, with the adjustment of the move strength to the situation, with the limitation of moves in social situations that require calm behavior. The utterances of people with ADHD are accompanied by numerous hand gestures. The hyperactivity is particularly visible in case of younger patients, but the increased motor readiness still remains in adult life, negatively inuencing social functioning.The purpose of this work was the objective actigraphic evaluation of movement at children with ADHD (Attention Decit Hyperactivity Disorder) in relation to the evaluation of symptom intensication according to parents (ADHD-RS IV) and a medical qualication to a subtype of ADHD (DSM IV TR). Method: The motor activity of a child was evaluated by means of an actigraph - Actiwatch 4 produced by Cambridge Neurotechnology Ltd. The motor activity was calculated from 72 h, from 2-minute consecutive measurement periods typical of chronobiological examinations. There was isolated time of daily and night activity, there was determined the time (an hour out of twenty-four hours) of peak maximum motor activity (cosine peak).The investigated group consisted of 37 children (32 boys, 5 girls). Results: The total scoring of the ADHD RS-IV scale above the 90 percentile (93 and 98), which shows undoubted ADHD diagnosis, was noted in case of 72% of children, and equal to the 90 percentile or above the 80 percentile in case of 28%. There were not observed any differences in the activity between the group of children with recognizes ADHD combined subtype and the group of children with recognized ADHD predominantly inattentive subtype.There was not observed any difference in the intensity of average scoring of the ADHD RS-IV scale at boys in comparison to girls.More serious attention disorders occur in case of children, who in later hours have the maximum activity intensity. The scores of items evaluating the hyperactivity and impulsiveness did not correlate with the results of activity measurement. Conclusion: The results of actigraphic measurement did not correlate with the evaluation of the activity intensication according to parents.

P-26-09 Use of a virtual classroom in a french population: a comparative study between children with ADHD and control children S. Bioulac*, S. Kedziora-Lallemand, P. Philip, C. Fabrigoule, M. Bouvard * Bordeaux, France Objective: Use of virtual reality tool is interesting for the evaluation of Attention Decit Hyperactivity Disorder (ADHD) patients. The virtual environment offers the opportunity to administer controlled task like the typical neuropsychological tools, but in an environment much more like standard classroom. The aim of this work was to compare performances of ADHD patients and controls at an attentional task embedded in the context of a virtual classroom, with a focus on the evolution of performances over the blocks of trials. Method: Design and methods: 36 boys (7 to 10 years of age) comprising 20 ADHD subjects and 16 controls completed the virtual classroom task. We compared ADHD performances between control performances through the ve successive blocks of the virtual classroom. We also compared attentional performances recorded in the virtual classroom with measures of the Continuous Performance Test (CPT II). Results: ADHD children had signicantly less correct answers than control subjects in the virtual classroom. ADHD children, contrary to controls, showed a signicant worsening of performances over the successive blocks. This worsening appeared as early as the second block. Furthermore, virtual classroom measures correlated with CPT II measures. Conclusion: The new French version of the virtual classroom was able to distinguish performances in children with and without ADHD. This work showed a signicant deterioration of performances over time for only ADHD children but not for controls. This ecological instrument constitutes a good clinical tool for evaluation in ADHD and for studying impact of time on task effects.

P-26-08 AQT cognitive speed and processing efciency differentiate adults with and without ADHD: A preliminary study N. P. Nielsen*, E. H. Wiig * Kbenhavn, Denmark Objective: To evaluate if a quick test of cognitive speed (AQT) processing speed would differentiate ADHD adults pre- and posttreatment with methylphenidate and normal controls.

P-26-10 Different neuropsychological proles in Wechsler Intelligence Scale for Children-fourth edition (WISC-IV) between ADHD subtypes and ADHD with symptoms of Sluggish Cognitve Tempo in patients naive E. Camprodon*, R. Nicolau, L. Duno, M. Garca-Giral, S. Andres, S. Batlle, N. Ibanez, X. Estrada, M. Acena, L. M. Martin * Barcelona, Spain

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186 Objective: Attention Decit Hiperactivity Disorder (ADHD) is one of the most common mental health disorders of childhood. In the DSM-IV (TR)s subtypes of ADHD, Combined (C), Inattentive (I) and Hiperactivity-Impulsivity Type are accepted. Some studies suggest the existence of subgroups more homogeneous and it is proposed enlarge the actual symptoms list of DSM-IV TR. As nd other criteria to do subgroups. Specically the construct of Sluggish Cognitive Tempo (SCT) has been associated in a ADHD-I and some studies suggest that it takes part from another clinical entity. Other studies also found in non ADHD clinical groups. Findings support the statistical of the SCT construct, but its clinical utility is still unclear. The aim of this study is to determine whether differences exist between neuropsychological proles of The Wechsler Intelligence Scale for Children (WISC-IV) in the subgroup of ADHD-C, ADHD-I and ADHD with symptoms of SCT in naive patients. Find diferences between of Child Behaviour Checklist proles (CBCL, Achenbach) of different subgroups. Method: This is a multicenter study. The patients were selected from the Child and Adolescent Mental Health Service (CAMHS) Sant Mart and the Hospital Clinic (Barcelona) (N=57). Age range: 7 to 11 years old. Three groups: ADHD-C (N=24), ADHD-I (N=13) and ADHD with symptoms of SCT (N=20). SCT symptoms were assessed in these subjects by means of CBCL scale. A descriptive cross-sectional study design were purpose. Study of descriptive stadistics for age, gender and subgroups. Results: Expected signicant differences between the proles of the WISC-IV. The group of ADHD with symptoms of SCT saved differs signicantly slower cognitive prole of other groups. Signicant differences were found in multivariate ANOVA analysis between all groups (p\0.01). Find signicant differences between the proles of Achenbachs CBCL. Conclusion: Patients with ADHD with symptoms SCT show different neuropsychological proles in the WISC IV compared with other groups. Conclusion: The SR-WRAADDS demonstrated acceptable psychometric properties. It separated clinical from normative subjects. It demonstrated acceptable internal consistency. The SR-WRAADDS correlated well with the original investigator rated version at baseline and much better when addressing treatment effects. The factor structure differed from the investigator version signicantly. It includes additional items not a part of the Utah or DSM criteria.

P-26-12 Measuring restlessness and focus in the context of everyday life in Adults with Attention Decit Hyperactivity Disorder, before and after treatment with psycho-stimulant medication C. Skirrow*, Y. Malliaris, P. Asherson * London, United Kingdom Objective: We measured symptoms relevant to Attention Decit Hyperactivity Disorder (ADHD) using the Experience Sampling Method (ESM). This allows for the unbiased assessment of experiences and their variability (measured using the standard deviation). Using this measure we aimed to uncover whether increased intraindividual variability, commonly seen in reaction-time tasks, is present in everyday experiences of ADHD symptoms. Furthermore, we aimed to discover how symptoms measured in this way respond to psychostimulant medication. Method: We compared psychiatrically healthy men (N=45) to men with ADHD (N=30) before treatment initiation. Follow-up assessments were completed in a sub-group of ADHD patients (N=14) after stabilization on psychostimulant medication, and controls (N=21) roughly matched for duration of follow-up. Participants completed the Barkley Adult ADHD Rating Scale (BAARS). At both time-points participants used the iMonitor (myiMonitor.com), a portable electronic device, for 5 days which cued them 8 times daily to report on levels of focus, and mental and physical restlessness. Analyses were conducted using non-parametric tests. Results: Baseline symptoms measured using the iMonitor correlated well with BAARS ratings (all measures of restlessness: rho=.58-.64, p\.001; focus variability: rho=.46, P\.001; focus mean: rho: .10, p[.05). ADHD patients reported greater mental and physical restlessness than controls (p\.001) at baseline, as well as greater variability in all three measured domains (mental and physical restlessness p\.002, focus p\.01), but no differences in mean focus. At follow-up signicant differences remained only for mean mental restlessness (p\.05). Conclusion: ADHD-relevant symptoms measured using ESM correlate well with an established clinical measure of ADHD symptoms. Untreated ADHD patients report higher levels of restlessness than control participants, but no difference in mean levels of focus. Interestingly, ADHD patients report greater variability in all three measured domains which were no longer different following treatment; only the greater mental restlessness remained after treatment.

P-26-11 Psychometric properties of a self report version of the Wender Reimherr Adult Attention Decit Disorder scale F. Reimherr*, B. Marchant, E. D. Williams, R. J. Robison, C. Halls, C. Pommerville * Salt Lake City (UT), USA Objective: The seven domains contained in the Utah Criteria for ADHD in adults (Attention Difculties, Hyperactivity/Restlessness, Temper, Affective Lability, Emotional Over-Reactivity, Disorganization and Impulsivity) have been previously assessed using the investigator-rated Wender Reimherr Adult Attention Decit Disorder Scale (WRAADDS). A self-report version of this scale (SR-WRAADDS) has been created which assesses these domains plus the associated areas of: Oppositional Deant Disorder (ODD), Academic Impairment, and Social Adjustment. Method: ADHD adult subjects were collected from two clinical trials of methylphenidate in adults with ADHD.1,2 Normative subjects were males and females ages 20 to 49 without current psychiatric illness. Results: Discriminate validity (normative versus ADHD adults) was signicant for all domains (p\.001). Internal consistency was acceptable with all item-total correlations above 0.38 and Cronbachs Alpha=.86. Factor analysis resulted in 3 factors accounting for 86% of the variance. There was signicant agreement between the SRWRAADDS and investigator rated WRAADDS for related domains (r[.3, p\.001) at baseline. There was substantial agreement regarding treatment response (placebo versus methylphenidate) between the SRWRAADDS and WRAADDS (r[.7, p\.001).

Saturday, 28 May 2011, 14.3016.00 P-27 Epidemiology: Children and adolescents III
P-27-01 A different look at the prevalence of Attention Decit Hyperactivity Disorder and epilepsy R. Cohen*, Y. Senecky, R. Raz, G. Chodick, V. Shalev, A. Shuper, D. Inbar, Y. Senecky

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187 * Petach- Tikva, Israel Objective: Epilepsy and Attention Decit Hyperactivity Disorder (ADHD) are frequently inter-related childhood disorders. There are more epileptiform or electroencephalographic (EEG) abnormalities among children with ADHD, and more cases of ADHD among children with epilepsy than in the general population. We investigated the prevalence of both disorders from the perspective of primary care physicians, as opposed to hospital-based clinics. Method: This investigation was conducted in the Maccabi Healthcare Services (MHS), the second largest HMO in Israel, insuring 1.8 million members nationwide. The study population included all pediatric subscribers aged 6-13 years. Information about the presence of a formal diagnosis of ADHD was retrieved from the physicians records and transferred to a central computerized database. Epilepsy was dened as the purchase of at least ten prescriptions for anti-epileptic medications as reported from the MHS pharmacies. Adjusted odd ratios for the presence of epilepsy were calculated by multivariate logistic regression models using SPSS software (SPSS Inc., Chicago, Ill). Results: The study population included 284,419 children (51.5% boys), with a mean age of 9.4 years (SD=2.3 years). The prevalence of epilepsy in the total study population was 5 per 1000 children and the prevalence of ADHD was 12.6%. The prevalence of ADHD among epileptic children was 27.2%, and the risk of epilepsy among ADHD children was almost twice that of the general population. Conclusion: The national prevalence of ADHD and epilepsy among children was extrapolated from computerized data obtained from primary care physicians and pharmacies of a large community-based HMO. Although the clinical data which supported these diagnoses were not available to us, this methodology is nevertheless useful for obtaining reasonable estimates of the prevalence of these two disorders. to have ADHD. Longitudinal studies are needed to better understand the mechanisms underlying the association between ADHD and overweight/obesity.

P-27-03 A community-based longitudinal controlled cohort study of children with ADHD D. Efron*, E. Sciberras, J. Nicholson, V. Anderson, P. Hazell * Parkville, Australia Objective: Previous longitudinal studies investigating the long-term outcomes of children with ADHD have used clinical samples, which tend to over-represent children with more severe symptoms and comorbidities, while under-representing girls and children with ADHDInattentive subtype. In a community-based sample of children we aim to: 1) measure ADHD symptoms over the early years of school; 2) evaluate the extent to which children with ADHD have elevated risks for poor academic, mental health, and social outcomes compared to non-ADHD controls; and 3) assess the inuence of ADHD subtype and severity, comorbidities, and other child, family, and school factors on childrens mental health, academic and social outcomes. Method: Over 2 consecutive years, approximately 5,300 Grade 1 children across 34 schools in Melbourne, Victoria will be screened for ADHD, using Conners Parent and Teacher Rating Scales Revised (ADHD Index subscale). Children with scores one standard deviation above the mean by both parent and teacher report will be assessed further. Their parents will complete a face-to-face standardized diagnostic interview (DISC-IV) to determine whether their child meets criteria for ADHD and/or any other psychiatric diagnoses. A control group (classroom peers matched for gender) will be selected from the sample of children screening negatively. Parents and teachers of children in both groups will complete baseline questionnaires covering child and family variables. Children will also undergo a face-to-face cognitive and academic assessment. Follow-up parent and teacher questionnaires will be completed at 12, 24 and 36 months. At 36 months, the DISC-IV and direct child assessments will be readministered. A pilot study was conducted in 9 schools in 2009-10, demonstrating good feasibility and acceptability. Results: We will test the following hypotheses: Compared to the control group, children with ADHD will have poorer outcomes at 36 month follow-up including: a) More mental health diagnoses b) More total mental health and peer relationship problems, and lower psychosocial quality of life c) Lower mean academic achievement in literacy and numeracy. Conclusion: This will be the rst Australian study, and one of only a few internationally, to provide longitudinal evidence on risk and protective factors for a community sample of children with conrmed ADHD. We plan to follow these children through adolescence and into adult life. The ultimate goal of this work is to identify the key modiable early life risk and protective factors in children with ADHD. The ndings will be relevant to families, mental health, education, allied health and medical professionals, and policy makers.

P-27-02 Examining the relationship between Attention Decit Hyperactivity Disorder and overweight in children and adolescents - results from the BELLA-study B. Sawitzky-Rose*, M. Erhart, N. Wille, B. Herpertz-Dahlmann, H. Holling, U. Ravens-Sieberer * Hamburg, Germany Objective: Although a higher prevalence of overweight/obesity was reported in clinical samples of patients with Attention Decit Hyperactivity Disorder (ADHD), an association between overweight and ADHD has yet not been assessed in the general population. As both disorders are common and signicantly impact on psychosocial functioning, we investigated the prevalence of ADHD in German overweight/obese youth and vice versa. Method: In a cross-sectional nationally representative and community based survey 2863 parents and their children aged 11-17 years rated symptoms on a DSM-IV-based German ADHD Rating scale. Weight and height were assessed by professionals. Body mass index was categorized according to national age and sex specic reference values. Results: Overall, 4.2% of the respondents met criteria for ADHD. The prevalence of ADHD was signicantly higher for overweight/ obese (7%) than for normal weight (3.5%) and underweight (4.9%) children. In a logistic regression analysis controlling for age, gender and socio-economic status, overweight/obese children were twice as likely to have an ADHD diagnosis (OR = 2.0). Vice versa, adjusting for all covariates, children with ADHD had an OR of 1.9 for overweight/obesity status. For all weight-status groups, children with ADHD more frequently reported eating problems as compared to their non-clinical counterparts. Overweight/obese respondents with ADHD displayed the highest level of health services utilization. Conclusion: A clinician should be aware of the signicant risk for a child with ADHD to become overweight and for an overweight child

P-27-04 Attention Decit Hyperactivity Disorder in Turkish preschool children S. S. Basgul*, S. Saltk, A. Beyhun * Istanbul, Turkey Objective: Behavioral and emotional problems experienced in early childhood may have a major impact on the development and functioning of a child, leading to a number of psychiatric problems at a later age. A child with Attention Decit Hyperactivity Disorder

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188 (ADHD) has difculty playing alone for more than a short time, destroys rather than plays with toys, and may have few friends because of aggression and inability to cooperate in play. Because of children behaviors are also consistent with a variety of other diagnose, including normal behavior for age or developmental level, diagnosis of ADHD in preschool children is difcult. Scales can be used in addition to the clinical examination to evaluate the incidence of psychiatric disorders. Childhood Inventory-4 (ECI-4) is used to evaluate the incidence of psychiatric disorders in the early childhood period. The purpose of the present study was therefore is to determine the frequency of ADHD in 3 to 6 year-old children presenting at the Outpatients Department. Method: The population sample was selected from 3- to 6 year-old children presenting at the Goztepe Research and Training Hospital, Child Psychiatry and Child Neurology Departments in Istanbul. An interview based on the DSM-IV (1994) diagnostic measures was performed with the children and the family; and the child was observed in a free play environment during the interview; and scores from parent-completed ECI-4. Results: Of the 145 children in the study, 93 (64.1%) were boys and 52 (35.9%) were girls. The mean age was 4.250.08 years. According to the results of ECI-4, 55 patients (53.7%) were diagnosed ADHD. When these patients were reevaluated clinically, the diagnosis of ADHD was corrected in 32 (22.1%) patients. The other diagnoses clinically corrected were intelligence disability in 6 patients, autism in 5 patients, child depression in 3 patients. Nine patients were normal development-related behavior. Conclusion: Our results showed that, ADHD may be seen more common than expected in preschool children. But, it is rather difcult to differentiate certain types of normal development-related behavior from psychiatric disorders in the early childhood period because of children develop rapidly in that period. these children, some were found to be in a depressive/anxious state, while others were deant, delinquent, and occasionally antisocial. The YSR attention problems subscale may enable valuable research in future, providing an easy-to-use and useful diagnostic tool for these children.

P-27-06 Does one out of seven nine-year old boys suffer from ADHD? The increasing administrative prevalence of ADHD in Germany, 20032009 M. Schlander*, O. Schwarz, G.-E. Trott, T. Banaschewski, W. Scheller, M. Viapiano, N. Bonauer * Wiesbaden, Germany Objective: In our earlier health care utilization studies (for year 2003), we observed an administrative prevalence rate of ADHD in Nordbaden (a region in the South-West of Germany with a population of [2.7 million) of 0.53%, with a peak among nine-year old boys at 8.43%. The aim of the present study is to establish a longitudinal ADHD patient database and to assess changes of ADHD diagnosis rates by age and gender during years 2003 to 2009. Method: Patient-level data were extracted for analysis from the physician-centered claims database of the Kassenaerztliche Vereinigung (KV) in Nordbaden/Germany, completely covering the regional population enrolled in statutory health insurance ([2.2 million). Age and gender specic one-year prevalence rates of ADHD were determined for years 2003 through 2009. Results: During the study period, the overall one-year ADHD prevalence rate increased from 0.53% to 0.95%. ADHD (hyperkinetic disorder: ICD-10, F90.0, F90.1) prevalence rates were highest in the age group 6-12 years (peak [2008] among nine-year old children, 10.01%; boys, 13,68%), increasing continuously during the observation period (a) age group 6-12: from 4.75% (boys, 6.91%; girls, 2.46%) to 8.01% (boys, 11.04%; girls, 4.82%); (b) age group 13-17: from 1.73% (boys, 2.66%; girls, 0.75%) to 4.22% (boys, 6.27%; girls, 2.02%); adults (age [18 years): from 0.04% (males, 0.05%; females, 0.03%) to 0.17% (males, 0.22%; females, 0.12%). Conclusion: The administrative prevalence rate of ADHD in Nordbaden/Germany almost doubled during the six-year study period. From 2003 to 2009, methylphenidate prescriptions in Germany grew even 2.75-fold, thus outpacing the increase in ADHD diagnoses from 2003 to 2009. Further research seems warranted looking into the underlying dynamics of physician group involvement, health care utilization patterns, and economic implications.

P-27-05 Attention problems and other psychosocial issues among junior high school students in Japan H. Ozawa*, N. Nakazawa, Y. Kusumoto, R. Iwanaga, A. Imamura * Nagasaki, Japan Objective: Attention Decit Hyperactivity Disorder (AD/HD) is a common developmental condition causing several psychosocial problems. We investigated approximately 5,000 junior high school students in Nagasaki, Japan, to examine the prevalence of AD/HD symptoms among children and the psychosocial problems they face. Method: The attention problems subscale of the Youth Self-report (YSR) questionnaire was used to examine the prevalence of AD/HD symptoms, and associated issues. Of the 5,374 students attending nine junior high schools, 4,977 participated in this survey and 4,864 (90.5%) provided valid responses. Logistic regression analyses were performed to test the association between attentional problems and other items, adjusted for sex and school year. Results: The results revealed that 3.9% of participants were included in the clinical range, and 10.4% were included in the clinical/borderline range on the YSR attention problems subscale. Attentional problems were signicantly associated with a range of social and behavioral problems (suicidal ideation: OR = 4.42, 95% CI 3.60-5.42; smoking: OR = 3.70, 95% CI 2.29-5.97; violence from adults in the home OR = 3.19, 95% CI 2.32-4.38; irritability when exchanging e-mails: OR = 2.93, 95% CI 2.26-3.82; being bullied: OR = 2.82, 95% CI 2.20-3.51; difculty falling asleep due hypersensitivity to noise: OR=2.32, 95% CI 1.85-2.91, self-harming behaviors: OR = 2.32, 95% CI 1.64-3.28). Conclusion: The results of the current study suggested that the YSR attention problems subscale could be used to identify children exhibiting AD/HD symptoms, especially of the inattention type. Among

P-27-07 The direct cost of Attention Decit Hyperactivity Disorder (ADHD) in Germany An age and gender specic analysis M. Schlander*, O. Schwarz, G.-E. Trott, M. Viapiano, N. Bonauer, W. Scheller * Wiesbaden, Germany Objective: International studies have reported that patients with ADHD incur higher health care costs than persons without this condition, but little is known about the direct medical costs associated with ADHD in Germany. Method: Health care resource utilization data for patients with a diagnosis of ADHD (ICD-10 codes F90.0 and/or F90.1) were extracted from the Nordbaden claims database (year 2003), covering the complete regional population insured by Statutory Health Insurance SHI (2.238 million lives in 2003), and were combined with SHI prescription data. Complete datasets were available for 3,831

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189 outpatients with ADHD and for a randomly selected control group matched 1:1 by age and gender. For costing, resource use was valued applying SHI acquisition costs. Results: The annual average expenditure per patient was 650 versus 251 for matched controls, with physician charges accounting for 68% (444 versus 170 for controls). Consistently across subgroups dened by age and gender, all categories of costs were higher for patients with ADHD by a factor of 2 to 5 versus controls. Average costs per patient with ADHD increased with age (age group \7 years, 520; 7-12 years, 622; 13-19 years, 661; [20 years, 1,147), primarily reecting higher medication costs. In contrast, average costs per control person showed little change across age groups (at 269, 245, 250, and 272, respectively). Among children and adolescents, there were no substantial spending differences by gender. Conclusion: These data are likely underestimates of the total expenditures attributable to ADHD since they do not include costs of ergotherapeutic interventions, which will be addressed in future studies. They nevertheless provide robust information from Germany on the signicant nancial burden for the SHI attributable to ADHD. Results: In the sample of children with ADHD, the rate of children who were breastfed only, more than 4 months is signicantly less than the controls (P = 0.0001). Duration of breastfeeding was negatively correlated with bottle-feeding (P = 0.01) and pacier use (P = 0.01). Total duration of breastfeeding was negatively correlated with nailbiting (P = 0.05). Girls were more likely to have a history of thumbsucking (P = 0.03). Conclusion: ADHD appears to be associated with various factors relating to oral sciences. Multidisciplinary research with larger sample sizes is needed.

P-27-09 Maternal rejection, family and cognitive factors: Modeling aggression in children with ADHD E. Ercan*, E. S. Ercan, B. Kabukcu Basay, T. Uysal * Izmir, Turkey Objective: To explore the relationship of maternal rejection, family and cognitive factors to aggression of ADHD children as reported by teacher and parents. Method: The study participants consisted of 309 (254 boys, and 55 girls) elementary school age children (7-15 years) with Attention Decit Hyperactivity Disorder (ADHD) combined type or inattentive types and other disruptive behaviour disorders who have normal IQ. The children evaluated with a semistructured interview (Schedule for Affective Disorders and Schizophrenia for SchoolAge Children- Epidemiologic Version (K-SADS-E), and all diagnostic decisions made by using best estimate procedure. Approval from the Facultys review board was attained. Child Behaviour Checklist (CBCL), Teacher Report Form (TRF), DSM-IV Turgay Attention Decit Disorder, Childrens Aggression Scale-Parent and Teacher Versions (CAS-P, CAS-T), Parental Acceptance and Rejection Questionnaire (PARQ); were used in the study and also Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (TDSM-IV-S) was used as a screening instrument in this study. For Cognitive evaluation WISC-R administered by a trained psychologist to estimate the childs overall IQ.Structural equation modeling was used to examine the differential relationships of maternal rejection, family and cognitive factors to aggression in the home and school settings. Results: The principal nding of this study is that family risk factors are associated with pervasive aggressive behavior in children that spans the home and school setting.The model showed that (N = 309; Chi-Square = 464.16; df=143;RMSEA = 0.085) family factors inuenced aggression reported at home and at school. Cognitive factors

P-27-08 Breastfeeding and parafunctional oral habits in children with Attention Decit Hyperactivity Disorder: A preliminary report O. Sabuncuoglu*, A. C. Orengul, A. Bkmazer * Pendik/Istanbul, Turkey Objective: In spite of the fact that, children with ADHD were reported to have shorter duration of breastfeeding, oropharyngeal implications of this nding have not been studied. The less children are breastfed, the more they are bottle-fed and engage in non-nutritive sucking habits which negatively affect their dentofacial development. Since these issues have never been addressed in children with ADHD, we aimed to investigate them in this study. Method: The study group consisted of 68 children and adolescents with ADHD, aged 7 to 17 years. Conners Parent and Teacher Rating Scales were used to assess behavioral disturbances. A questionnaire was developed consisting of items pertaining to breastfeeding period, bottle-feeding experiences, non-nutritive sucking habits, mouth breathing and dental problems. Breastfeeding data was compared to 40 healthy school children.

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190 inuenced aggression reported at school. Maternal acceptance and rejection inuenced aggression reported at home. Conclusion: Our ndings indicate that maternal rejection and family factors effects aggression in home setting and suggest that interventions for clinically referred children should target both the individual and his/her family. assessed included hospital admission related to injuries/poisoning (ICD-9 codes 800-999). Incidence rates were calculated by dividing number of events by person-years (PY). Poisson regression analysis was used to adjust crude incidence rate ratios for covariates. Results: The study cohort comprised 1397 patients initiating ADHD treatment and 8382 controls. About 80% of patients were boys and almost two-third initiated ADHD drugs between 6-11 years of age. The rate of hospital admissions was two times higher in the ADHD cohort (11.2 vs. 5.6/1000 person-years), yielding a crude incidence rate ratio (IRR) of 2.00 (95% CI: 1.53-2.62). Adjustment for comedication at baseline had a modest effect: adj. IRR 1.83 (95% CI 1.382.43). Over half of the events were fractures (adj IRR 1.40, 95% CI: 0.93-2.10), followed by intracranial injuries (adj IRR 2.30, 95% CI 1.15-4.62). Stratication by sex showed that risk estimates were higher in girls then in boys (adj. IRR 2.60, 95% CI 1.20-5.61 vs. 1.69, 95% CI: 1.24-2.30) and were the highest among 12-18 year olds (adj. IRR 1.99, 95% CI: 1.38-2.88). Conclusion: The incidence of hospital admissions for injuries and poisoning was two times higher among youth with treated ADHD compared to controls. Due to the serious nature of the outcomes, this represents only the tip of the iceberg. The higher relative risk among girls could be explained by their lower background risk of injury.

P-27-10 Are psychostimulants overprescribed in Brazilian schoolaged children? A nationwide study M. Arruda*, M. V. Moura-Ribeiro, J. H. Golfeto, M. E. Bigal, G. Polanczyk * Ribeirao Preto, Brazil Objective: 1) To conduct a nationwide populational study to estimate the prevalence of psychostimulants use in Brazilian school-aged children; 2) To estimate agreement between gold-standard diagnosis (Diagnostic and Statistical Manual of Mental Disorders, DSM-IV) and parental report of previously medical diagnosis of ADHD. Method: Sample consists of 5,961 children (4 to 18 years) recruited at the school system in 87 cities of 18 Brazilian states (represented of all Brazilian regions). Parents and teachers were interviewed using a standardized questionnaire with validated modules. ADHD was ascertained as per the DSM-IV criteria and the Mental Health Status with the validated Brazilian version of the Strengths and Difculties Questionnaire (SDQ). Results: According to the parental report, 2.1% of children were in use of psychostimulants and 7.7% had been previously received a medical ADHD diagnosis. Of children with a parental report of previous medical diagnosis of ADHD, 23.7% had DSM-IV diagnosis; of children with DSM-IV diagnosis, 58.4% had not been diagnosed (false negatives); of children using psychostimulants, only 27.3% had ADHD according to the DSM-IV. Diagnostic agreement was higher in boys than in girls (p = 0.01) and in those of lower income vs. higher income (p = 0.04). Paradoxically, psychostimulants were more frequently used by girls vs. boys (p = 0.02) and by those of higher incomes (p \ 0.001). Conclusion: The low agreement between medical diagnosis and goldstandard diagnosis of ADHD is strikingly low; similarly, agreement between diagnosis of ADHD and use of psychostimulants is also very low. These results point out important concerns under the ADHD diagnosis and the prescription of psychostimulants in Brazilian school-aged children. Of interest is that children of higher income are less likely to have an ADHD diagnosis and more likely to be treated for ADHD. It may be that social pressure at least partially explains the paradox.

Saturday, 28 May 2011, 14.3016.00 P-28 Epidemiology: Children and adolescents IV P-28-01 Difference in Internet uses between normal adolescents and ADHD
C. Arrizabalaga*, A. Aierbe Barandiarana, M. C. Medrano Samaniego * San Sebastian, Spain Objective: In todays culture, characterized by the proliferation of media, adolescents have become the biggest users of the Internet. In many parts of Spain, the Internet has overtaken television, not only as a source of entertainment and recreation among teenagers, but also as a vehicle for socializing. Adolescents suffering from Attention Decit Hyperactivity Disorder (ADHD) have specic characteristics that may make them more vulnerable when using new technologies. The general objective is to identify some indicators of Internet and television consumption proles and their comparison between people with and without ADHD, within a broader cross-cultural study. Method: This is a descriptive and comparative research and we have used The Television Viewing Habits Questionnaire CH-TV 0.2. Regarding reliability, this questionnaire presents an acceptable Alpha coefcient: .8826. The study involved a total of 232 individuals, divided into two subsamples: normal adolescents and adolescents with ADHD. The sample was designed following the needs of the study. Thus, the subjects with ADHD had to be registered in the Red Sanitaria Publica (Public Health Network), had to study both in public and private schools, and/or had to be linked to an association of ADHD victims and families. Results: The results, which are based on a sample of 232 adolescents from the Basque Country (Spain), indicate differences on Internet use proles between adolescents with ADHD and the normal adolescent population. Contrary to our hypothesis, the former group uses the Internet less than the latter. The former group has an average of 4.31 h versus 9.10 of the latter and these differences are statistically signicant Furthermore, despite the fact that for both sample groups the principal purpose of using the Internet was communication, there are statistically

P-27-11 Accident proneness among youth treated with ADHD medication E. van Den Ban*, P. Souverein, W. Meijer, H. van Engeland, H. Swaab, T. Egberts, R. Heerdink * Utrecht, The Netherlands Objective: To study differences in hospital admissions for injuries between youngsters treated for ADHD and age and sex matched controls. Method: Data were obtained from the Dutch PHARMO record linkage system. From a random sample of 150,000 subjects aged 0 to 18 years, we identied all patients initiating treatment with ADHD drugs. For each patient with ADHD, six patients without ADHD drug use were sampled on year of birth, sex and calender time. Outcomes

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191 signicant differences in the use of Internet for downloads and play. In relation to parental mediation, teenagers with ADHD reported a higher degree of instructive and restrictive mediation. Conclusion: The results obtained in this study draw a picture that indicates some inconsistencies regarding the object of study. The low scores about parental mediation generally agree with previous research, which concludes with data on the existence of a low level of parental mediation. If we examine the data in its totality, it could be argued that there are differences in the consumption prole of teens with ADHD and normal adolescents. 1986 (N=9432 alive born children). In the 15-year follow-up, the parents assessed inattention and hyperactive symptoms of their offspring by completing the Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire. The information on any injuries that needed hospital admission was gathered from the national Hospital Discharge Register. The longitudinal associations between injuries occurred between the ages of 6 to 15 years and inattention/hyperactivity symptoms at the age of 15 were studied by using Cox regression analysis. Results: The preliminary results showed that the most common injuries in the cohort were fractures (7.0%), dislocations without fracture of joint structure (3.8%) and intracranial injuries (2.8%). Compared to those without ADHD symptoms, adolescents with ADHD symptoms had a higher risk for any trauma or injury (boys RR 1.4, 95% CI 1.1-1.9 and girls RR 2.8, 95% CI 1.9-4.2) and especially for fractures (boys RR 1.7, 95% CI 1.1-2.5 and girls RR 2.7, 95% CI 1.3-5.6). Girls with ADHD symptoms had a higher risk for dislocations without fracture of joint structure (RR 2.5, 95% CI1.1-5.4) and for intracranial injuries (RR 4.0, 95% CI 1.7-9.7). Conclusion: It seems that the symptoms of ADHD may increase the risk for injuries. Preventive work could be directed more to families with children with ADHD.

P-28-03 ADHD and the family context as a mediating variable and modulating J. M. Garcia Cruz*, M. Rodriguez Ruiz, I. Iraurgi Castillo, J. A. Fernandez de Legaria, E. Perez Fernandez de Landa, T. Sota Leiva, I. Ocio Ocio, M. Landabaso Vazquez, J. M. Jimenez Lerma, J. Caceres Carrasco * Vitoria, Spain Objective: To explore and analyze whether there is a relationship between family functioning and parenting styles in the presence of ADHD among children. to estimate the prevalence of adhd in a group policy from a screening instrument for three sources familiar answer: mother, father and child himself Method: we performed an observational cross-sectional correlational study which involved 250 children (100 belonging to a clinical group and 15o to a student sample) and at least one parent. respond to a battery of family functioning (faces,ea,ene) and screening of ADHD in children (adhd was answered by them and their oparents) and adults (ASRS). Results: Of the three sources of information on ADHD for which the mother is more appropriate with a sensitivity of 89% and specity of 75%.from this source is estimated prevalence in adhad in the school group was 17,1%. have observed a wide range os statiscally signicant associations between family variables and greater expressions of symptons of adhd, but proved theoretically important were: family adapatation, family stress, the expression of rejection by both parents and a rigid style of education by both parents. Conclusion: there is a further deterioration of family relationships in the clinical group with respect to student group, which could be affecting the symptomatic expresion of minors. More longitudinal research to dene more precisely the causations lines is necessary.

P-28-05 Child sexual abuse and ADHD A.-K. Koch*, W. Retz, S. Boureghda, M. Rosler, P. Retz-Junginger * Homburg, Germany Objective: The prevalence of child sexual abuse (CSA) is lower in boys than in girls (Fergusson et al., 1996; MacMillan et al., 1997). A German epidemiological study found the prevalence of CSA to be approximately 16% in girls and 6% in boys (Schotensack et al., 1992). There is a limited body of research available on the possible link between Attention Decit Hyperactivity Disorder (ADHD) and CSA, which displays conicting results. The current retrospective study attempts to uncover the prevalence of ADHD in victims of CSA. Method: In the current study 210 written forensic-psychiatric assessments of alleged CSA victims, which were conducted between 2000 and 2009 at the Institut fur gerichtliche Psychiatrie und Psychologie in Homburg, Germany, were analyzed. The sample consisted of 175 females between the ages of 2 and 38 years (M =14.8, SD = 5.9) and 35 males between the ages of 4 and 26 years (M = 12.6, SD = 5.3). Odds ratios for childhood ADHD were calculated. Results: No signicant differences were found on measures of IQ; number, duration and type of CSA; and offender-victim relationship. ADHD was diagnosed in 36 persons, or 17.1% of the sample. The prevalence of ADHD in the German general population is 4,8% (Schlack et al., 2007). Thirteen of the thirty-ve males and twenty-three of the 175 females had been diagnosed with childhood ADHD. There was an increased chance for a positive ADHD diagnosis in the total sample, as well as in both genders individually (Odds Ratio OR = 4.1; OR = 9.7; OR = 15.1 for the total, female and male samples, respectively). Conclusion: Results of the current study suggest that the prevalence of ADHD is increased in CSA victims.

P-28-04 Are injuries of children and adolescents associated with ADHD symptoms A study in the Northern Finland Birth Cohort 1986 T. Hurtig*, I. Moilanen, H. Ebeling, J. Jokelainen, A. Taanila * University Of Oulu, Finland Objective: Injuries and traumas are one of the main causes of death among children and adolescents in the Western countries. Therefore, it is a great public health concern to investigate the underlying factors, for example, if there are groups of children and adolescents who are more prone to accidents. One of these groups may include those with Attention Decit Hyperactivity Disorder (ADHD). Being a developmental neuropsychiatric disorder, its symptoms of inattentiveness and impulsivity may be related to the increased risk for injuries. Thus, our aim was to examine the association between childhood and adolescence injuries and adolescent ADHD symptoms. Method: The sample is based on a population-based prospective mother-child birth cohort, the Northern Finland Birth Cohort (NFBC)

P-28-06 Symptoms of adult Attention Decit Hyperactivity Disorder and stress in Korean soldiers C.-S. Lee* * Jinju, Republic of Korea Objective: ADHD in children continues through to adulthood in 30% to 70% of cases. In work related settings, adults with ADHD had

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192 lower job performance ratings overall. All able-bodied South Korean men must serve in the armed forced or undertake equivalent tasks. Some soldiers may have trouble adapting to life in the military. Sometimes a soldiers difculty in adjusting to life in the military can have serious social repercussions which are often signicant threats to individual safety and security. There have been a number of psychopathologic studies associated with dysfunctional soldiers often regarding the effects of depression and subsequent suicides. The aim of this study was to investigate the relation between symptoms of adult Attention Decit Hyperactivity Disorder (ADHD) and stress among South Korean soldiers. Method: A cross-sectional study of 131 soldiers conducted as a part of a public mental health program. According to the cutoff scores of the stress scale, Brief Encounter Psychosocial Instrument (BEPSIK), soldiers were divided into two groups, those with high to moderate stress (N=34) and those with low stress (N=97). They were also evaluated using the Korean adult attention decit hyperactivity scale (KAADHS), Korean Wender Utah rating scale (KWURS) aside from demographic factors such as rank, age, religion and level of education. These ADHD and stress scales were used in previous Korean studies and showed high validity and reliability. Student t-tests, Pearson Correlation Tests and logistic regression tests were performed. Approval for this study was granted by the Institutional Review Board, Gyeongsang National University Hospital. Results: The scores of Adult ADHD symptoms in KAADHS and K-WURS were correlated with the stress scores of BEPSI-K (r=0.529, p\0.001 and r=0.484, p\0.001) and higher in groups with high stress compared with the control group (p= 0.002, p=0.001). Scores of adult ADHD in KAADHS were the most signicant risk factors for stress compared with other factors like age, level of education, military rank, religion and ADHD symptom scores in two different ADHD rating scales (O.R=1.198, 95% CI= 1.104-1.299). Conclusion: Our ndings suggest that it may be important to consider the treatment of adult ADHD in soldiers within in military and also after military discharge. P-28-07 Public health issues in ADHD Brazilian children S. M. Motta Palma*, D. M. Cruz, E. Rosangela * Sao Paulo, Brazil Objective: To discuss and evaluate the implementation of Public Policies for children and adolescent with ADHD in a large Brazilian city (Sao Paulo) in which 70% of the population dependent on public health service. Method: We analyze the data from our databases regarding the number of the children served and number of drugs distributed. We assed the impact of care protocol for children and adolescents with ADHD that includes rigid diagnostic criteria, and information obtained in the spleens of public data regarding the number of patients seen and number of medications distributed. Results: There are 2.541.327 children and adolescents aged 5 to 19 yars old in the city of Sao Paulo and approximately 127.000 individuals with ADHD. Our services attended only 189 children and adolescents in the period of 12 months. Conclusion: It is estimated that more than 75% of children and adolescents with mental disorders do not receive the needed services (National Advisory Mental Health Council, 2001). Our dates suggest a signicant problem with the undertreatment of ADHD and the need to an implementation of appropriate public policies. P-28-08 Attention Decit Hyperactivity as factor of socially unacceptable behaviour N. Kepes* * Zenica, Bosnia and Herzegovina Objective: Some children with ADHD syndrome cause themselves and the community serious problems, so there is a need for intervention. This in particular addresses the children whose behaviour is extreme and due to that reason they are excluded from regular education. This work is only one modest contribution in enlighten of this problem which on exact way analyses ADHD occurrence and etiologic. The main purpose of the research is to identify the proportion of phenomena of society unacceptable behaviours and to reveal its nature of connection with row of factors which bring to such ADHD Method: The gathering of information took place in 2010 year, on a representative sample of Bosnia and Herzegovina with primary and high school students (N= 1080). ADHD behaviour was examined by means of an adapted Scale for self-expressing comprising 32 individual behaviours grouped into types of behaviour. Results: By observed of done results it is conrmed that our rst sub hypo these which assume that male students more express phenomenon of ADHD than female students. Research rejected the second hypothesis according to the social deviations are mostly urban phenomenon. Our third hypothesis is not conrmed because outside family factors do not have any statistical signicance on the phenomenon of ADHD. Our fourth sub hypothesis proved that inside family factors are statistically signicant predictors which are related with the phenomenon of ADHD. However, statistically signicance approved relation of suffered violence with ADHD. It conrmed our fth sub hypothesis. Conclusion: Analyse of done dates show that there are 28,8% students who demonstrate ADHD. It manifests with permanent antisocial behaviour with signicantly of disseminated collapse of relations with other children and social disorder of behaviour in which juveniles are mainly well integrated in the group of the same age.

P-28-09 Prevalence and risk factors for Attention Decit Hyperactivity Disorder in Brazilian school-aged children A nationwide study M. Arruda*, M. V. Moura-Ribeiro, J. H. Golfeto, M. E. Bigal, G. Polanczyk * Ribeirao Preto, Brazil Objective: To assess the prevalence of Attention Decit Hyperactivity Disorder (ADHD) in a national sample of Brazilian school-aged children and investigate the effect of demographic characteristics and correlated risk factors. Method: Sample consists of 5,961 children (4 to 18 years) recruited at the school system in 87 cities of 18 Brazilian states (representing all geographic regions from Brazil). Parents and teachers were completed the Swanson, Nolan and Pelham Questionnaire - version IV (SNAPIV), a rating scale that lists all 18 symptoms of ADHD according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV). General psychopathology and impact were assessed with the validated Brazilian version of the Strengths and Difculties Questionnaire (SDQ). Results: The overall point prevalence of ADHD was 4.4%; it was signicantly higher in boys than in girls (6.7% vs. 2.1%, odds ratio [OR] = 3.3, 95% condence interval [CI] = 2.4-4.4), in non-white vs. white (5.8% vs. 3.8%, OR = 1.5, 95% CI = 1.2-2.0), in children coming from lower social class (OR = 2.8, 95% CI = 1.9-4.1) and in

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193 children of divorced parents (OR = 2.2, 95% CI = 1.7-2.8). Correlated risk factors signicantly associated with ADHD are intra-uterus exposure to tobacco (OR = 1.9, 95% CI = 1.4-2.6) and alcohol (OR = 2.5, 95% CI = 1.7-3.6). The OR of SDQ scores in all dimensions were signicantly higher in those with ADHD versus controls. Conclusion: Based on our data, over 1.9 million of children and adolescents in Brazil have ADHD. Interventions should screen for ADHD in families at risk. Future studies should to understand the putative mechanisms implicated on the association between socioeconomic factors, parents0 marital status and prenatal exposure to tobacco and alcohol. is known about ADHD in adults, especially university students with ADHD. Research about the prevalence of ADHD has had different results, the reason of which may be employing different measures and denitions and using various tools and individuals for evaluation. This research, investigates the prevalence of ADHD and its subtypes among university students of Markazi province in center of Iran. Method: The method of this research was descriptive- cross sectional survey. Participants included 1776 university students (584 females, 1192 males) that were selected using random cluster sampling. The Wender Utah Rating Scale (WURS-2000) and The Diagnostic Scale of Delavar, Alizadeh, Mireskandari (2008) completed by participants. Data analysis was conducted using descriptive statistics, correlation coefcient and ANOVA by SPSS. Results: Results showed that total prevalence of Attention Decit Hyperactivity Disorder was about 5.4%, and 5.4% among males and 5.5% among females. The total prevalence of ADHD by self-report in Wender Utah Rating Scale was 6.7%. Prevalence of attention-decit, hyperactivity inattentive and combined type was 5.4, 6.5, and 7.2 percent respectively. Prevalence of ADHD between males and females students approximately was equal. Conclusion: Prevalence of Attention Decit Hyperactivity Disorder among university students was more than ndings of few researches. Diagnosis, offering psychological services and early consultation is required for this disorder.

Saturday, 28 May 2011, 14.3016.00 P-29 Epidemiology: Adults II

P-29-01 Prevalence of ADHD and psychiatric comorbidity in adults attended in a Spanish mental health unit. K. Knecht*, T. Blanch, R. De Alvaro, V. Ferreres, N. Castillo, F. Romero, V. Balanza * Valencia, Spain Objective: To establish the prevalence of ADHD in a psychiatric adult outpatient sample. To estimate which psychiatric disorders appear most commonly among ADHD patients and to compare them with non-ADHD subjects. Method: The sample comprised all patients 18-55 year-old who where attended in rst visit in the Mental Health Centre of Villarreal, Spain, over a 1-year period (1st June 2009 to 31st May 2010). All patients with a positive result in the screening instrument (ASRS v1.1) and a random subsample of patients with a negative result were invited to join the study. Trained mental health professionals conducted comprehensive clinical interviews (MINI, SCID-II, WURS, ADHD Rating Scale-IV) to conrm ADHD diagnosis as well as to evaluate other psychiatric disorders. Results: Out of a total sample of 427 outpatients, 79 had positive scores in the screening. A subsample of 111 patients (79 positives and 32 negatives) was further evaluated. ADHD was conrmed in 53 patients (12,4% of the sample). Major depression, anxiety disorders and personality disorders were the most common comorbidities (over 50%) of ADHD. Post-traumatic stress disorder, hypomania, personality disorders and substance use disorders were signicantly more prevalent in ADHD patients when compared with non-ADHD subjects. Only one patient was referred to psychiatrist with suspected ADHD. Conclusion: ADHD can be found among adult psychiatric outpatients, with similar prevalence rates to previous studies. Differences in psychiatric comorbidity seem to exist between ADHD and nonADHD patients. Suspected ADHD as a referral reason is exceptional still in our clinical setting.

P-29-03 Prevalence of adult Attention Decit Hyperactivity Disorder (ADHD) in Japan: Results from Hamamatsu epidemiological survey M. Ohnishi*, K. Nakamura, S. Uchiyama, K. Takebayashi, K. Osumi, M. Tsujii, N. Mori * Hamamatsu City, Japan Objective: The prevalence of Attention Decit Hyperactivity Disorder (ADHD) in the U. S. general adult population has been estimated to be 4.4% (Kessler et al., 2006). Despite growing interest in adult ADHD, little is known about its prevalence in Japan. In this study, we report the prevalence of adult ADHD in the general population in Japan. Method: 10,000 18-49-year-old community dowering adults were selected, and questionnaire including Adult ADHD Self Report ScaleScreener (ASRS-Screener: Kessler et al., 2005), gender, age, family member, marital state, occupation, and income was sent to them. Semi-structured interview using Conners Adult ADHD Diagnostic Interview (CAADID) were carried out with participants, oversampling those with ASRS positive screen results. Results: 3910 individuals respond to questionnaire (response rate was 39.1%) and 196 of them were screened positive (criterion: ASRS-screener [4 point (3 point: N=306)). The estimated prevalence of current adult ADHD in Japan was about 1.2% from diagnostic interview, and it was lower than that of the United States (Kessler et al., 2006). Conclusion: This study has implications for understanding prevalence of adult ADHD and comorbid psychiatric disorders in Japanese community sample, and for planning treatment them.

P-29-02 Epidemiology of attention Decit Hyperactivity Disorder in Islamic Azad university students of Markazi Provincecenter of Iran K. Ganji*, M. Asgari, F. Tork * Malayer, Iran Objective: According to the American Psychiatric Association [DSMIV-TR, 2000], Attention Decit Hyperactivity Disorder (ADHD) affects 37% of the school aged population and 24% of the adult population. ADHD is probably the most common chronic undiagnosed psychiatric disorder in adults. Relative to the childhood literature, less

P-29-04 Pre- and perinatal risk factors in adult Attention Decit Hyperactivity Disorder (ADHD): A population-based nested casecontrol study A. Halmy*, K. Melve, R. Skjrven, J. Haavik * Bergen, Norway Objective: To investigate the association between pregnancy- and birth complications and ADHD in adulthood.

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194 Method: A population-based nested case-control study using data from the Medical Birth Registry of Norway (MBRN). A national cohort of adults clinically diagnosed with ADHD between 1997 and 2005 (n=2323) was compared to the remaining adult population born in Norway in the same time period (n=1 170 073). Main outcome measures were pre- and perinatal factors as systematically reported in the MBRN, including maternal health factors (diabetes, hypertension, epilepsy, and preeclampsia), gestational age, birth weight, delivery complications, Apgar scores and congenital malformations. Relative risks (RR) adjusted for potential confounders were calculated. Results: Adults with clinically diagnosed ADHD were 1.3 and 5.0 times more likely than the controls to be born preterm (\37 weeks of gestation) and extremely preterm (\28 weeks of gestation), respectively, and 1.5 and 2.1 times more likely to have birth weights \2500 g and \1500 g, respectively. Five minute Apgar scores \4 and \7 were associated with 2.8- and 1.5-fold increased risks of persisting ADHD, respectively. Maternal epilepsy (RR 1.7, 95% CI 1.1 to2.7) and offspring oral cleft (RR 2.8, 95% CI 1.6 to 4.9) also occurred more frequently among adults diagnosed with ADHD. Conclusion: Low birth weight, preterm birth and low Apgar scores increase the risk of ADHD persisting up to 40 years after birth. The consequences and implications for individuals and society are important as increasing proportions of newborns now survive unfavourable pregnancy and birth conditions. The increased risk of ADHD related to maternal epilepsy and infant oral cleft warrants further investigation to explore possible causal mechanisms. P-29-06 ADHD in the elderly organisation of daily life and emotional problems over the lifespan F. Philipp-Wiegmann*, I. Rauber, A. Schmitt, M. Bauer, W. Retz, M. Rosler * Homburg, Germany Objective: 296 adults aged over sixty were tested for the occurrence of ADHD over the lifespan (before and retrospective after the 50th year of life) and co-morbidities using standardized procedures (Barkley Interview, WRAADS, ADHD-DC, Sheehan-Scale, Checklist of co-morbid disorders). Method: 63.6% of persons with ADHD are male, 36.4% are female. Results: Subjects with ADHD report having problems in daily life substantially more often than the control group before as well after their 50th year of life. This became apparent in school-education, work-occupation and other areas of life such as organization of daily life and economic activity. Across the lifespan there is found a reduction of symptoms concerning self-condence and short temper in probands with ADHD. The symptoms of persons without ADHD are largely unchanged. The subscale social anamnesis presents that probands with ADHD have more sudden mood alterations and temperamental outbursts than the non-ADHD group. The symptoms of the ADHD group decrease during the course of life as well. The subscales emotional labiality and stress intolerance of WRAADS show an enhanced incidence of symptoms in persons with ADHD compared with persons without ADHD. Especially in severe respectively medium manifestation it becomes clear. Conclusion: Participants with ADHD report substantially more often having ADHD-typical problems with the organization of daily life. These impairments are explored to prevail throughout the entire lifespan up until old age. Similarly, seniors with ADHD describe themselves as also being more impaired in daily life than the agematched control group. It is possible that persons with ADHD have disorders in emotional regulations across the lifespan. It is assumed that the symptoms can decrease during the course of life. But it seems that they persist in a greater extend till the elderly in comparison to the population without ADHD.

P-29-05 Life quallity in ADHD at the olders D. Lazic*, L. Puskas, R. Ristic-Dimitrijevic, M. Nenadovic, J. Kovacevic, D. Macesic-Petrovic, J. Karic, S. Marinkovic * Belgrade, Serbia Objective: The most dramatic characteristics of the ADHD are that in ADHD the mental processes: attention, language, interpersonal relationship appear to go completely awary. People with this disorder save touch with the real world but their behavior is atypical according to their peers. Demage of reticular formation of central nervous system is accuse for patoanatomy sypstrat of this syndrome. Method: Sample was formed from 40 participants, chronologically distributed from 27 to 40 years old, gender distributed approximately about 80% of male participants. They were treated in period of ten years ago. The sample was tested by standard interview and scales such as Scaling of Life Events (Pykel) than Scale the Quality of LifeSOFAS scale, and nally, Olsons Scale of Interpersonal Relationships (Olson). They were treated in hospital and extrahospital settings and some of them were treated like as forensic cases. Results: Almost all of them (upon the 80%) have the problem with interpersonal communication same as they have educational problems including with professional problems (problems with saving the jobs). They often loose their jobs according with interpersonal conicts. They have trouble with respect their authority including teachers, parents, goverment, policeman, judge, etc. Upon the 79% of them couldnt live in their own homes and they live with parents, 40% are married, 58% are divorsed in the rst year of the marriage. Conclusion: The quality of life of this persons is seriously changed, they approach a lower level of education, there jobs are with lover payment and they usually live with their parents although they can be married. Unfortunelly, most of them had troubles with law.

P-29-07 Teachers knowledge about Attention Decit Hyperactivity Disorder (ADHD): The case of Saudi Arabia K. Alkahtani* * Riyadh, Saudi Arabia Objective: Teachers are frequently expected to engage in the assessment and treatment process of children with ADHD because of their frequent contacts with them. They can play a key role in helping to identify students with the disorder, and also can implement appropriate interventions to assist them with their learning. The overall aim of this study is to provide information to develop a predictive model for teachers knowledge and attitudes toward the disorder and those suffering from it in a Saudi context. Method: A questionnaire survey covering a total of three hundred and ve elementary teachers carried out in ten schools at Riyadh. The Knowledge of Attention Decit Disorder Scale (KADDS) was translated to Arabic and used along with a demographic questionnaire as the survey instruments. Descriptive statistics and correlation test were used to analyze the data.

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195 Results: In general, teachers knowledge of ADHD was insufcient. Scores on Treatment and Associated Features subscales were lower compared to Symptoms/Diagnosis subscale. The overall knowledge of ADHD was unrelated to the years of teaching or the age of teachers. The level of teachers knowledge was positively related to teacher attitudes toward children with ADHD, self-efcacy, prior exposure to a child with ADHD, extra reading about ADHD, and attending workshops on ADHD. Conclusion: Students with ADHD are already in mainstream schools. Their sense of belonging, development, and identity as effective learners may be enhanced through additional support for their learning. Special education programs provided by the Saudi government for students with special needs expanded dramatically from 12 in 1996 to 3,130 in 2009. However, none of these programs aimed to serve students with ADHD. Results of this study point toward the need for services and programs for students with ADHD and their teachers. Courses on ADHD, educational interventions, and behavioral management are recommended. P-29-09 Prescription ADHD stimulant non-medical use in adult substance abusers entering treatment: Early ndings from the NAVIPPRO system T. Cassidy*, E. McNaughton, S. F. Butler, S. Varughese, L. Russo * Newton, Ma, USA Objective: To examine early data from NAVIPPRO (National Addictions Vigilance Intervention and Prevention Program) regarding non-medical use (NMU) of prescription stimulants in adults entering substance abuse (SA) treatment. Method: NAVIPPRO monitors NMU of prescription drugs from a network of treatment centers in the United States. We used a standard interview intended to help with treatment planning, the ASI-MV Connect, which collects self-reported data from adult patients during admission, including product-specic data on past 30-day NMU, routes of administration and procurement. NMU is dened as using a medication not prescribed to you or using your own medication in a way not prescribed to you. Data were reviewed from 53,069 SA admissions from 420 treatment facilities in 35 states during October 1, 2009 through September 30, 2010. Results: Among all admissions, past 30-day NMU of any prescription stimulant was reported by 1.1% compared to 17.3% for any prescription opioid and 11.1% for any sedative. Among prescription stimulants, past 30-day NMU for immediate release (IR) amphetamine was 0.55% followed by extended release (ER) amphetamine (0.49%), ER methylphenidate (0.25%), and IR methylphenidate (0.22%). At a brand level, past 30-day NMU for ER mixed amphetamine salts (0.38%) was higher than lisdexamfetamine dimesylate (LDX) (0.12%) and OROS methylphenidate (0.09%). Of respondents reporting NMU of an oral prescription stimulant, 80.3% administered it orally, followed by snorting (39.2%), and injecting (11.9%). Most who used a prescription stimulant non-medically obtained the medication from a friend/family (53.7%), followed by using their own prescription (24.6%), and dealer (23.0%). Conclusion: Compared with other prescription medications prone to NMU, NMU of stimulant medications in adult patients entering SA treatment is relatively rare. Observed levels of NMU varied between different prescription stimulants with LDX and OROS methylphenidate having lower point estimates for NMU than other ADHD stimulant medications examined. Sponsored by Shire Development Inc.

P-29-08 Nonmedical use and diversion of specic ADHD stimulants among U.S. adults aged 18-49: A national internet survey T. Cassidy*, T. A. Eaton, S. F. Butler, S. H. Budman, S. Varughese, L. Russo * Newton, MA, USA Objective: Adults representative of the U.S. population were surveyed to estimate rates of nonmedical use (NMU) of ADHD prescription stimulants (RxS) and rates across specic products, to describe diversion of RxS and to identify reasons for NMU of RxS. Method: 10,000 respondents, who were representative of the U.S. general population, recruited from an opt-in Internet panel, were surveyed. Results: Lifetime NMU for prescription drugs was reported by 35.1% of respondents. Lifetime NMU for pain medications was 24.6%, 15.6% for sedatives/tranquilizers, and 9.9% for sleep medications. Lifetime NMU of RxS was reported by 8.1%, of which 21.3% had ever been prescribed a stimulant. The greatest frequency of past year NMU of RxS was immediate-release mixed amphetamine salts (MAS IR; 1.2%), followed by mixed amphetamine salts extended-release (MAS XR; 0.6%), immediate-release methylphenidate (MPH IR; 0.4%), OROS MPH (0.2%), and lisdexamphetamine dimesylate (LDX; 0.07%). After adjusting for product availability in the year 2009, the past year NMU cases/100,000 prescriptions were MAS IR 1.61 (95%CI = 1.31, 1.90), MPH IR 1.62 (95% CI = 1.10, 2.13), MAS XR 0.62 (95% CI = 0.46, 0.78), OROS MPH 0.19 (95% CI = 0.10, 0.31) and LDX 0.13 (95% CI = 0.05, 0.27). Diversion was mainly from family/friends without any differences between specic products. Swallowing whole was the highest reported route for all RxS products. MAS XR was the RxS most used nonmedically for wakefulness (61.2%) and performance (57.1%). MPH IR was the RxS used most often to get high (31.7%). Conclusion: For adults, lifetime NMU for RxS was less than prescription pain medications, sedatives/tranquilizers, and sleep medications. Within the RxS category, past year NMU was highest for MAS IR. There was no difference between the rate of past year NMU of OROS MPH and LDX when taking product availability into account. Sponsored by Shire Development Inc. Citation: Cassidy, T.A., et al. (2011, May) Nonmedical Use and Diversion of Specic ADHD Stimulants among U.S. Adults Aged 18-49: A National Internet Survey. Poster session presented at the 164th Annual Meeting of the American Psychiatric Association, Honolulu, HI.

P-29-10 Parenting stress and efcacy of the mothers of children with Internet addiction and Attention Decit Hyperactivity Disorder D. Lee*, B. Choi * Seoul, Republic of Korea Objective: The purpose of this study was to compare levels of parenting stress and efcacy in mothers of children suffering from Attention Decit Hyperactivity Disorder (ADHD) and internet addiction disorder IAD), mothers of children with ADHD alone only, and those with normal children. Method: Participants were composed of 25 mothers of children with ADHD and IAD, 35 mothers of children with ADHD alone, and 50 mothers of normal children. They completed the Patenting Stress Index (PSI) and Parenting Sense of Competence (PSOC). Results: In comparison with the mothers of normal children, the mothers of children with ADHD and IAD and the mothers of children with ADHD alone showed signicantly higher levels of parenting stress and lower parenting efcacy. However, a comparison of mothers of children of children with ADHD and IAD with those of children with ADHD alone did not show any signicant differences in their levels of parenting stress or efcacy.

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196 Conclusion: Mothers of children with ADHD, regardless of the presence of IAD exhibited a higher level of parenting stress and a lower level of parenting efcacy than mothers of normal children. performance, school behavior, peer relationships and family functioning, directly inuencing the quality of life of sufferers. This study aimed to evaluate the quality of life of children with ADHD combined subtype. Method: We evaluated children aged eight to twelve years, compared with a group without the disorder and relating to the perception of their parents or caregivers. In total 88 children participated in the study, in all cases their parents or caregivers answered the quality of life scale PedsQLTM.. Of these 45 were study group and 43 in the control group. There was no statistical difference between groups in gender, family income, parents marital status, fathers and mothers education, showing similarity in both groups. Results: The self-reported, the group with ADHD had scores lower than the control group in all domains assessed. The difference was signicant for the social aspect (p = 0,010), school activity (p \0,001), psychosocial health (p \0,001) and overall quality of life (p = 0,002). The physical functioning domain and emotional aspect did not differ signicantly between groups, p = 0,841, p = 0,070, respectively. In the perceptions of parents/careers, the children with ADHD had lower scores in all domains. In this case there was a signicant difference in all domains - physical functioning (p \0,001), emotional (p \0,001), social functioning (p \0,001), school activity (p\0,001), psychosocial health (p\0,001) and overall quality of life (p \0,001). Conclusion: The relationship between self-reported child and parents reports indicated that there is greater agreement among the group with ADHD, except in school activity, which suggests that the child with the disorder and their father has the perception of functional limitation that the disease brings.

P-29-11 ADHD and pathological gambling J. Ringling*, W. Retz * Homburg, Germany Objective: Is there a relationship between pathological gambling and ADHD? Method: 161 pathological gamblers (F63.0) were tested for childlike ADHD and adult ADHD using the WURS-k (Retz-Junginger 2002) and the ADHS-SB (Rosler et al. 2004). A special questionnaire for the assessment of pathological gambling was developed. Results: 5% of the pathological gamblers had a childlike ADHD, 24.2% had an adult ADHD (29.2% lifetime ADHD). In the group of the lifetime ADHD were found signicant results for the of F-diagnoses (p=.006), neurotical disorders F4 (p=.041), drugs and alcohol abuse (p=.012) and personalty disorder (p=.000). The severeness of the pathological gambling was increased concerning the gamblers with lifetime-ADHD. The functionality of gambling in the group of lifetime-ADHD showed a wanted sedative effect (p=.000). Experience of violence (p=.002) and previous convictions (p=.012) were signicant too. Conclusion: The group of pathological gamblers with a lifetimeADHD has a higher rate of comorbidity. The functionality of gambling is related to drug abuse. A increased rate of personality disorder is estimated and should be investigated in the future.

P-29-12 ADHD, Traumatic Brain Injury (TBI) and driving automobiles. D. Smith* * Vancouver, Canada Objective: This poster is a review of the literature in regards to the connection between ADHD, TBI and driving. Method: Review of Literature Results: Persons with ADHD are poor drivers and have higher levels of accidents and subsequent TBI. Individuals with TBI and no preexisting ADHD can develop Secondary ADHD (SADHD) as a result of damage to the frontal lobes of the brain. Treating persons with ADHD will improve their driving abilities and reduce car accidents and TBIs. Both ADHD and SADHD can be effectively treated. Conclusion: Individuals with ADHD and SADHD will bent from treatment, including improvement of driving skills.

P-30-03 Experience and perception of ADHD: Impacts on coping in private and work life
C. Bonnes* * Frankfurt Am Main, Germany Objective: Recent research on adults with ADHD has mainly been focusing on diagnosis, medication and therapy. Only little is known about the psychosocial impact of ADHD, for example how people with ADHD cope or cope not with developmental challenges despite the obstacles that they encounter throughout their biography. The presented qualitative study focuses on the biographical development as well as on possible resources and risk factors throughout the lifespan in reference to the specic effects that ADHD can have to ones life. Method: To get a deeper understanding of the phenomena, 28 semistructured interviews have been conducted with adults who have been diagnosed with ADHD. It was possible to capture a wide range of age (18 56 years), profession and social environment. All cases were analyzed for biographical patterns, and contrastive cases were analyzed with content analysis. Results: The data shows that important areas of life (e.g. family, partnership, social relations, school career and professional development) are heavily affected by ADHD symptoms. However, especially remarkable are cases where the individual seems to cope very well. From the data it can be inferred that there are internal and external resources inuencing the individual development throughout the life course. One important aspect is how the individual experiences the ADHD symptoms and how the ADHD diagnosis affects his or her self-perception. Conclusion: The study yields new insight into coping processes of adults affected by ADHD especially when the diagnosis comes later in life. The results are enriching the picture we have of ADHD and can give important impulses to enhance the improvement of therapy and personal development through trainings and educational measures.

Saturday, 28 May 2011, 14.3016.00 P-30 Life quality I P-30-02 Quality of life in Brazilian children with Attention Decit Hyperactivity Disorder combined type
J. Marques*, E. Barbante Casella, J. Goulardins, M. Periotti, S. Pacheco, T. Freire, U. Reed * Sao Paulo, Brazil Objective: The Attention Decit Hyperactivity Disorder (ADHD) is associated with losses in several contexts, including academic

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197 P-30-04 Attention Decit Hyperactivity Disorder is associated with impairment in everyday life as reported by parents of affected children: Results of the European Lifetime Impairment Survey H. Caci*, P. Asherson, M. Doepfner, R. Donfrancesco, S. V. Faraone, M. Fitzgerald, A. Hervas, T. Redston, D. Weber, A. Woods * Nice, France Objective: The Lifetime Impairment Survey (LIS) is a large panEuropean survey designed to establish the degree to which ADHD impacts patients everyday lives. Method: The survey was developed by a group of European ADHD experts in collaboration with a market research organisation and elded in six countries across Europe (France, Germany, Italy, The Netherlands, Spain, UK). Participants, derived from a panel of individuals who had previously agreed to take part in market research, were invited by email to complete the LIS online. Where quotas were not achieved from the database, additional recruitment methods were deployed (healthcare professional referral, patient website and telephone contact of previous survey respondents). Scale scores were calculated to compare the level of reported impairments between ADHD and control groups. Children aged \6 years were excluded from analyses relating to school experiences. Results: Results presented are from parents of children with/without ADHD (n=584/n=516) to questions relating to their childs experiences at home, at school, and in relationships. Survey responses illustrate a negative impact on children with ADHD in all aspects of life investigated. Scale scores demonstrate signicant impairments in the ADHD vs control group: a general impairment score of 2.72 1.17 was recorded for children with ADHD compared with 1.82 1.04 for control children (p\0.001). The mean score on the school impairment scale was 2.72 0.74 for children with ADHD compared with 2.09 0.72 for control children (p\0.001). There was a notable impairment on achievement at school: children with ADHD reported signicantly more school days missed (median: 7.0 vs 5.0, p\0.01) and were more frequently bottom of the class (27% vs 10%, p\0.001) than those without ADHD. Additional data from this population will be reported. Conclusion: Data from the LIS provide important information regarding the specic impairments associated with ADHD in childhood/adolescence. dangerousness of individuals with ADHD, socio-demographical factors as age, gender and ethnicity of the respondent or the target individual with an ADHD diagnosis, stigmatization of ADHD treatment, e.g. publics skepticism towards ADHD medication and disclosure of diagnostic status and medicational status of the individual with ADHD. Conclusion: The contribution of stigma associated with ADHD can be conceptualized as an underestimated factor affecting treatment adherence, treatment efcacy, symptom aggravation, life-satisfaction and mentally well-being of individuals affected by ADHD. Public concepts about ADHD are highly diverse, setting individuals with an ADHD diagnosis at greater risk to get stigmatized.

P-30-06 Relation of inattention and hyperactivity-impulsivity with childrens self-efcacy beliefs M. Gambin*, M. Pudlo, M. Swiecicka * Warsaw, Poland Objective: Hyperactivity-impulsivity and inattention affect childs functioning in diverse spheres of life and thus can have a negative impact on its self-efcacy beliefs. The aim of this study was to examine the relation of inattention and hyperactivity-impulsivity with childrens self-efcacy beliefs. Method: 295 children in the age range from 8 to 10 completed the Polish version of Childrens Self-Efcacy Scale. The scale consists of four subscales extracted in the factor analysis: 1) self-efcacy for academic achievement; 2) self-efcacy for self-control in social and school situation; 3) self-efcacy for the regulation of negative emotions 4) self-efcacy for the management of positive emotions. The Rating Scale for Teachers, constructed at the University of Warsaw, was completed for each child to measure the intensity of hyperactivity-impulsivity, two aspects of inattention (attention withdrawal and distractibility-fatigability) and emotion regulation difculties (tendency to low emotional control and excessive emotional control). Results: The results show that self-efcacy beliefs for academic achievement, self-control and regulation of negative emotion are negatively correlated with inattention, hyperactivity-impulsivity and low emotional control, whereas self-efcacy beliefs for the management of positive emotions are negatively correlated with excessive emotional control. Regression analysis has revealed that: 1) selfefcacy for academic achievement is best predicted by distractibilityfatigability; 2) the best predictors of self-efcacy for self-control in social and school situations are hyperactivity-impulsivity and distractibility-fatigability 3) self-efcacy for the regulation of negative emotions is best predicted by low emotional control 4) the best predictor of self-efcacy for the management of positive emotions is excessive emotional control. Conclusion: The implications of these ndings for therapy and education of children with symptoms of inattention and hyperactivityimpulsivity will be discussed.

P-30-05 Stigmatization in patients with Attention Decit Hyperactivity Disorder A. B. Furmaier*, A. K. Muller, L. Tucha, J. Koerts, K. W. Lange, O. Tucha * Groningen, The Netherlands Objective: Attention Decit Hyperactivity Disorder (ADHD) is a frequently diagnosed disorder in childhood and adulthood with a high impact affecting multiple facets of social life. Therefore, patients suffering from ADHD are at high risk to be confronted with stigma, prejudices and discriminating behaviour. Method: A review of the empirical research in the eld of ADHD with regard to stigma was performed. The ndings of investigations in this eld were clustered in different categories, including stigma in children with ADHD, stigma in adults with ADHD, stigma in relatives or in people close to a patient with ADHD and the inuence of stigma on authorities that are dealing with affected patients. Results: Identied variables that contribute to stigma in ADHD are publics uncertainty concerning the reliability/validity of an ADHD diagnosis and the related diagnostic assessment, publics perceived

P-30-08 Assessment of quality of life in adult patients with Attention Decit Hyperactivity Disorder (ADHD) I. Jansen*, M. Loewer, J. Schulte-Mater, B. Feige, A. Philipsen * Freiburg, Germany Objective: In recent years numerous studies have been performed to examine quality of life in children diagnosed with ADHD. Up to date little is known to what extend adult populations with ADHD are experiencing restrictions in the overall quality of life and its inuencing factors.

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198 Method: In 60 adult out-patients with carefully diagnosed ADHD according to DSM-IV criteria and 60 age, gender and education matched control subjects Quality of Life was assessed using the Scoring System for Quality of Life Enjoyment and Satisfaction Questionnaire (Q-Les-Q). The onset of ADHD-symptoms in childhood and its current degree of severity were examined with the Conners Adult ADHD Rating Scale (CAARS) and the Wender Utah Rating Scale (WURS). Depressive comorbidity was registered using the subscales for depressive symptoms of the Symptom-Checklist-90-Revised (SCL-90-R). The MannWhitneyWilcoxon-Test was applied as a non-parametrical test for the statistical assessment. Additionally a multivariate analysis of variance (MANOVA) was performed to quantify the inuencing effect of comorbid depression on Quality of Life. Results: We conrmed signicantly lower scores in almost all of the 93 items of the Q-les-Q in the ADHD group as compared to the control subjects. In the assessment of variables that might inuence quality of life in our sample the presence of depressive symptoms was identied as a relevant factor. However in the statistical assessment the subjects ADHD status accounts for a signicantly higher degree of impairment in all but two domains. Conclusion: In our sample we were able to demonstrate a relevant decrease of the overall quality of life of patients with ADHD in mostly all domains. Depression is seen as a strong inuencing variable on overall quality of life, yet is exceeded by the presence of ADHD in the degree of subjective impairment. Method: This analysis is a part of a study realized by ADHDs Unit of the Service to test the ADHD psychosocial treatment. To assess the quality of life it is used a 52-items self-administrated Kidscreen questionnaire- parent and children version. 101 cases, age average of 11,8 years old (SD:; range 8-15,5), 82 of them are males, 83% ADHD combined subtype and 47% with 1 or 2 comorbility disorders. Results: After controlling for age, ADHDs subtype and number of comorbility disorders, males had statistically signicant higher scores in the mood and emotions (F=1,786 p\0.05) and self-perception (F=4,205 p\0.05) scales. Controlling for sex, number of comorbility disorders and ADHDs subtype, the young ones, in the parents version, obtained statistically signicant higher scores in physical wellbeing (F=4,185 p\0.05), psychological well-being (F=6,843 p\0.05) self-perception (F=6,548 p\0.05), relation with parents (F=4,557 p\0.05) and school environment (F=10,374 p\0.05). Whereas in the children version, teenagers obtained a statistically signicant lower scores in physical well-being (F=3,533 p\0.05) and self-perception (F=4,205 p\0.05) scales. Controlling for age, sex and comorbility, the inattentive type presents a statistically signicant lower scores in the social support scales (F=2,391 p\0.05) in the parents version. Controlling for sex, age and ADHDs subtype, the number of comorbility disorders has a negative statistically signicant impact on the psychological well-being (F=6,843 p[ 0.05), mood and emotions (F=3,347 p\0.05), relation with parents (F=4, 57 p\0.05) and school functioning (F=10,374 p\0.05) according to the parents version. Conclusion: Females with ADHD had worse scores in mood and emotions and self-perception, teenagers specially. Teenagers with ADHD, males and females, physically valued themselves worse as they get older. Parents believe that teenagers value themselves worse in physical well-being, psychological well-being, self-perception, relation with parents and school environment. They also believe that children with inattentive ADHD subtype obtain lower social support of their peers. Parents attribute to comorbility disorders and getting older, a negatively effect in psychological well-being, relation with parents and school functioning. Comorbidity disorders if present also alter the mood and emotions.

P-30-09 Quality of life in children with Attention Decit Hyperactivity Disorder, before and during pharmacotherapy A. Kesic*, A. Lakic, D. Stevanovic * Belgrade, Serbia Objective: Attention Decit Hyperactivity Disorder (ADHD) is a developmental disorder whose basic events (hyperactivity, impulsiveness and attention decit) greatly disrupt daily functioning of these children. WHO Denition (1991.) of quality of life as the individual perception of his or her position in life, within the cultural context and value system he or she lives in, and relation to his or her goals, expectations, parameters and social relations. It is a broad ranging concept affected in a complex way by the persons physical health, psychological state, level of independence, social relationship to salient features of their enviroment. Therapy of ADHD requires multimodal approach, in which pharmacotherapy is a central place. Assesment of treatment effects of medicament therapy (sustained release methylphenidate-OROS formulation) on a quality of life children with ADHD. Method: DSM-IV R, SNAP-IV ratng scale for ADHD, Parent Questionnare KINDL, Kiddo KINDL (all measurement was before and one month after therapy aplication); statistical analysis Subjects: 20 children with ADHD and their parents. Results: 95% of all parents and 63% of children with ADHD, were reported to improve the of quality of life. Conclusion: The use of medications (sustained release methylphenidate-OROS formulation) in the treatment of ADHD signicantly affect the perception of improvement of life in children with ADHD and their parents.

P-30-11 The disorder for decit of attention with hyperactivity: The effect in the context of the family G. Marta*, N. Rosa, M. Laura, M. Jaume, V. Montse * Barcelona, Spain Objective: The aim of this study is to carry out a descriptive analysis of the familiar impact that implicates living with a child with ADHD assessing parents perceptions. Method: This analysis is a part of a study carried out in ADHDs Unit of the Service, to test the ADHD psychosocial treatment. To assess the familiar impact it was used a self-administrated questionnaire by Donenberg and Baker (1993) -parent version. 101 cases, age average of 11,8 years old (SD:2,35; range 8-15,5), 47% over 11 years old. 82 of them males, 83% ADHD combined subtype and 47% with 1 or 2 comorbidity disorders (according to semistructured interview KIDDIE-SADS). Results: There are not statistically signicant differences in the questionnaire subscales by sex. Parents of teenagers with ADHD had statistically signicant higher scores in feelings and attitudes to their children subscale (F = 3,742 p[ 0.05), in the couples relationship subscale (F = 9,060 p[0,05), and in the economy subscale (F = 5,239 p[ 0.05), controlling for sex, ADHDs subtype, and comorbility disorders. Families with children with ADHD combined subtype had statistically signicant higher scores in feelings - attitudes subscale (F = 3,742 p[ 0,05) and in social life subscale (F = 4,663 p[ 0.05) controlling for sex, comorbility and age.

P-30-10 The disorder for decit of attention with hyperactivity: Quality of life perceived by the patient and his parents G. Marta*, N. Rosa, M. Jaume, M. Laura, V. Montse * Barcelona, Spain Objective: The aim of this study is to carry out a descriptive analysis of the quality of life perceived by the subject and by his parents.

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199 Conclusion: As age increases and with the presence of ADHD combined subtype, according to the parents, there is a negative effect in feelings and attitudes towards their children, regardless of sex and number of comorbidity disorders. The ADHD combined subtype produces higher difculties in familys social life, regardless of age, sex and comorbidity disorders. And teenagers with ADHD increase couples relationship and economy problems. about his/her condition. The special feature of the survey was that the doctor had to assess the stress caused to the parents and the child by the AD(H)D symptoms, while the parents had to provide information on their own and their childs stress. Results: The school situation and the social problems caused by the condition were considered by the treating doctors to be the predominant stressful areas. The doctor assumed that the school situation would stress the parents more than the child him/herself. As far as they themselves were concerned, the parents found the school situation and the social situation to be very stressful, to approximately the same degree. As far as the child was concerned, the parents conrmed the doctors judgement that the social situation would be much more stressful for the children than the school situation. Overall, the stress caused by the AD(H)D symptoms themselves (motor functions, impulsiveness, difculty concentrating) was ranked much lower. Conclusion: The result of this study shows differences in the prioritisation of the stresses caused by AD(H)D. Whereas parents experience problems at school as particularly stressful, social problems are of paramount concern to the children.

P-30-12 Developing a needs assessment instrument for students with attention-related difculties in higher education T. Takahashi*, M. Iwabuchi * Nagano-Shi, Japan Objective: A new self-rating questionnaire was developed to identify the support needs of students with attention-related difculties in higher education. Reliability and validity of the questionnaire were examined in this study. Method: The instrument was designed to evaluate the levels of difculties that students experience in their daily life, not the competency or decits. They also include an item to ask whether the respondent wants to use support services regarding such difculties. This item may bring to these students with special needs, who often do not think of using support services, the awareness that they can use the services for their problems. The Support Needs Inventory for Students with Attentionrelated difculties (SNISA) consists of 8 subscales (49 items); three for core attention symptoms, two for adult symptoms, and three for secondary and co-morbid symptoms. The questionnaire was administered to 646 non-clinical university students. Results: Both test-retest reliability (.83 .91) and internal consistency coefcients (.77 .88) for the eight sub-scales were high. All subscales showed moderate to strong correlation with a self-rating ADHD Checklist (Takahashi & Shinoda, 2003). The core symptoms and the adult symptoms subscales showed weak to moderate correlation with cognitive abilities measured with the integrated visual and auditory continuous performance test (IVA-CPT; Sanford, 2009). Semi-structured interviews revealed that those who scored high on the questionnaire experienced symptoms similar to those with ADHD. Although many of them did not show interests in seeking for individual supports, some of them are interested in learning academic and organization skills. Conclusion: The SNISA is a reliable and valid instrument to evaluate support needs among students with attention-related difculties. This questionnaire could also be used to evaluate the effectiveness of the supports provided for students with ADHD.

Saturday, 28 May 2011, 14.3016.00 P-31 Life quality II

P-31-01 Parental experiences of diagnosis and treatment of Attention Decit Hyperactivity Disorder in children: results from the European Lifetime Impairment Survey A. Hervas*, P. Asherson, H. Caci, M. Doepfner, R. Donfrancesco, S. V. Faraone, M. Fitzgerald, T. Redston, D. Weber, A. Woods * Terrassa-Barcelona, Spain Objective: The Lifetime Impairment Survey (LIS) is a large, panEuropean survey comparing experiences of participants with and without Attention Decit Hyperactivity Disorder (ADHD). Method: The LIS was developed by a committee of healthcare professionals and implemented by a market research organization in six European countries (France, Germany, Italy, The Netherlands, Spain, UK). Subjects were recruited from a database of 487,533 individuals who had volunteered to participate in market research. The survey was distributed and completed online. Additional recruitment methods were deployed to achieve quotas (healthcare professional referral, patient website and telephone contact of previous survey respondents). History of ADHD diagnosis by a healthcare professional was self-reported. Here we focus on recognition and treatment of ADHD in children. Results: Responses were collected from 639 parents/caregivers of children with ADHD. The mean age of the children at the time of survey was 11.7 years (standard deviation [SD], 4.3) and at the time of diagnosis was 6.4 years (SD, 3.1). Parents reported consulting a mean of 2.9 (SD, 3.2) doctors before receiving a diagnosis, which was made after a mean of 26.8 (SD, 39.7) months. Almost half (46%) of children were currently receiving evidence-based prescribed pharmacological therapy, of which long-acting or extended-release methylphenidate was the most widely used. Satisfaction with current medication was expressed by 73% of respondents. Nonetheless, most respondents considered efcacy in controlling symptoms and reduced side-effects as important areas for improvement (83% and 82%, respectively). Further data from this population relating to satisfaction with and preferences for improvements to current ADHD medication will be reported. Conclusion: Individual experiences of ADHD diagnosis and management vary in Europe. Data from such surveys are valuable in

P-30-13 Impairments caused by AD(H)D Different assessments by doctor and parents H. Niederhofer*, B. Mueller * Rodewisch, Germany Objective: A cornerstone of the diagnosis of AD(H)D is the bringing together of different peoples judgements of the problems associated with AD(H)D. Only when the problem is considered severe by a variety of assessors (doctor, parents, teachers and the child him/herself) can AD(H)D be diagnosed. This survey therefore examines the extent to which the judgements of the treating doctors and the parents concerned agree or disagree. Method: Using a questionnaire, the relevant treating doctor and the parents of 109 children with a conrmed diagnosis of AD(H)D were asked about what, in their judgement, the child found most stressful

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200 identifying and addressing the primary concerns of patients and their caregivers relating to the management and treatment of ADHD. Method: 65 6-to 12-years-old children with ADHD and 61 controlled children and both of their parents participated in the study. Parents reported on conict with their spouses. Children were interviewed about their parents conict, their emotional and cognitive responses to interparental conict, including emotional reactivity, emotional dysregulation, self-blame, coping efciency, and family representation. All data were compared between children with and without ADHD. Results: The results indicated that children with ADHD reported witnessing more frequent, more intense, and unresolved interparental conicts than children without ADHD. However, children with ADHD reported less fear or scare emotional reactivity to interaprental conict. The differences in emotion dysregulation and self-blame regarding interparental conict were not signicant. Specially, Children with ADHD reported less coping efciency and lower constructive family representation than controlled children. Conclusion: Findings highlight the potential risk for children with ADHD experiencing frequent, intense, and unresolved interparental conict. They would not express emotional responses obviously, but they might feel lack coping efciency and attribute less secure family representation. Clinicians should pay more attention to the cognitive responses in children with ADHD, and foster adaptive forms of coping that increase childrens sense of efcacy in dealing with interparental conict.

P-31-02 Quality of life, functionality and adverse life events among adult patients with ADHD attended in a Spanish mental health unit K. Knecht*, F. Romero, V. Ferreres, N. Castillo, R. De Alvaro, T. Blanch, P. Silvia, A. Ribes, A. I. Garca, V. Balanza * Valencia, Spain Objective: To compare life quality, functionality and presence of adverse life events among a sample of adult outpatients with and without ADHD attending a mental health unit. To establish if ADHD subtype or clinical severity correlates with life quality or functionality. Method: The sample comprised all patients 18-55 year-old who where attended in rst visit in the Mental Health Centre of Villarreal, Spain, over a 1-year period (1st June 2009 to 31st May 2010). All patients with a positive result in the screening instrument (ASRS v1.1) and a random subsample of patients with a negative result were invited to join the study. Trained mental health professionals conducted comprehensive clinical interviews (MINI, SCID-II, WURS, ADHD Rating Scale-IV) to conrm ADHD diagnosis. An ad hoc questionnaire for adverse life events, WHOQOL-BREF and FAST functionality scale were also used in evaluation. Results: Out of a total sample of 427 outpatients, 111 patients were evaluated (53 ADHD, 58 non-ADHD). No differences were found between ADHD and non-ADHD patients in any WHOQOL domain neither in FAST total score. ADHD subjects had signicantly more functional impairment in cognitive functioning (p=0,022), nancial issues (p=0,039) and interpersonal relationships (p=0,012). Signicantly more adverse life events were reported by ADHD patients, including school absence, motor vehicle accidents, confrontation with coworkers, discharges, unstable partnerships, involvement in ghts and aggressions and prison dwelling (all p\0,03). No differences were found in functionality between ADHD subtypes. A positive correlation was found between ADHD Rating Scale-IV and FAST total scores (r=0,429, p=0,002). Conclusion: ADHD patients attending general mental health units seem to have more adverse life events and worse functioning in certain areas than non-ADHD patients. However, as ADHD is usually associated with psychiatric comorbidities in these settings, more studies are needed to clarify whether ADHD on its own can explain the worse functionality detected in our study.

P-31-04 Self-esteem, self-efcacy, and resources in adults with adhd P. E. Newark*, M. Elsasser, R.-D. Stieglitz * Basel, Switzerland Objective: Adults suffering from Attention Decit Hyperactivity Disorder (ADHD) are often exposed to a multiplicity of negative life outcomes and underachievement due to their neuropsychological impairments. Particularly, interpersonal, academic, and vocational difculties are common in individuals with ADHD. In addition, the bulk of the aficted persons suffer from psychiatric comorbidity. As a consequence to these numerous negative experiences, the formation of the individuals self-esteem and selfefcacy is often affected. Despite the adverse effects people with ADHD have to deal with, specic internal resources, such as enhanced creativity or resilience, are supposed to be characteristic of them. So far, however, very few studies have considered this perspective, and consequently, results with respect to the specic resources of adult ADHD are still owing, or inconclusive. The purpose of this study is to shed light on therapy relevant factors, such as self-esteem, self-efcacy, or resources in adults with ADHD. In particular, the authors want to examine whether untreated patients with ADHD differ from a healthy control group in the aforementioned factors. Method: A total of 100 adults participated in this study. 50 adults who met DSM-IV criteria for ADHD in adulthood (outpatient sample) were matched with a non-clinical sample in terms of age, gender and education. All participants were assessed with self-ratings: Symptom Checklist (SCL-90-R), Rosenbergs global self-esteem scale (revised version after Rosenberg), General Perceived Self-Efcacy Scale, Dicks Resources Checklist and (only for the non-clinical sample) the WHO-ADHD-Screener (German version: ASRS-v1.1) All ADHD patients passed through an extensive ADHD-screening procedure consisting of clinical interviews and rating scales by two experienced clinical psychologists. Results: To this point in time, the data analysis is still on-going. Therefore, results and conclusions cannot be depicted yet in detail. They will be presented at the conference.

P-31-03 Emotional and cognitive responses to interparental conict in children with Attention Decit Hyperactivity Disorder L.-Y. Shyu*, C.-B. Yeh, C.-W. Chang, C.-H. Tu * Taipei, Taiwan Objective: Numerous theoretical arguments suggest that families are likely to play an important role in the development and maintenance of ADHD. Based on these arguments, a large number of researches have examined the families of children with ADHD. Studies have shown that parents of children with ADHD, report lower marital satisfaction, engage in more interparental conict, but evidence is scarce regarding the inuence of interparental conict on children with ADHD. Guided by emotional security theory and cognitive contextual framework, this study investigates the emotional and cognitive responses to interparental conict in children with ADHD.

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201 P-31-05 Supporting students with ADHD: Indications for and effectiveness of teaching and exam accommodations D. Baeyens*, L. Van Dyck * Antwerp, Belgium Objective: Adolescents and young adults with ADHD show higher drop-out rates in school, are more likely to repeat years and are less likely to attend university. Additional care for this group of students is necessary to help them develop their potential. In this study we set out to make an inventory of teaching and exam accommodations used for young adults with ADHD in secondary school and higher education in Belgium. Next, we explored the effectiveness of these adjustments. Method: First, 91 institutes of secondary (SE) and higher education (HE) were enrolled in a qualitative study. Here, we investigated the presence of accommodations for ADHD (in comparison to learning disorders (LD)) as well as the requirements to obtain these accommodations. Secondly, we discussed our study results in interviews with the teaching staff and students with ADHD in order to give adequate interpretation to the ndings and to investigate the effectiveness of the most common accommodations. Results: Findings of the quantitative study indicated that institutes of SE (LD: 100%, ADHD: 75.5%) and HE (LD:100%, ADHD: 90.2%) offered signicantly more accommodations for LD than for ADHD (v2(1)=3.82, p=0.05). Interviews revealed that the selection of accommodations is made locally and on an intuitive basis, as there are no clear guidelines from the government. Students stress that many of the accommodations offered, are not effective and that they fear a stigma by making use of this kind of support. Because of the heterogeneous nature of ADHD, students demand individually designed accommodations. Conclusion: Our ndings indicate that while there is a clear need to give additional support to students with ADHD, there is no theoretical framework available to guide the selection and evaluate the effectiveness of teaching and exam accommodations. This explorative study gives some (rst) insights on relevant parameters for both clinical/teaching practice and research. P-31-07 Multidisciplinary allied, government and school support for children diagnosed and treated for Attention Decit Disorder in Western Australia D. Silva*, E. Hagemann, M. Howell, C. Bower * West Perth Wa, Australia Objective: To determine the level of support and services reported by parents/carers for children diagnosed and treated with ADHD in Western Australia. Method: Children who met the DSMIV or ICD10 criteria for ADHD and had commenced pharmacotherapy were identied by 8 Paediatricians across WA. Questions related to allied service needs and availability (speech therapy, occupational therapy, physiotherapy, psychology) in children prior to attending school and school age. Government support relating to the carers allowance and school support were reviewed. Results: 358 questionnaires were returned for analysis with an 81% response rate. Half the parents/carers reported that they were concerned about their childs development where 42%, 34%, 12%, and 19% required speech, occupation therapy, physiotherapy and psychology services in their preschool years respectively although service availability for these children was around 60%. In primary and high school the need for these services changed where 52% required psychology services were availability of these services was around 68%. The majority of children were recognised as requiring school support but only half of the respondents felt the school understood and addressed the needs of their child. 60% of parents/carers received a carers allowance where the majority found this to be inadequate nancial support for their child. Conclusion: ADHD is a common mental health condition recognised as a disability. A multidisciplinary approach to the management of ADHD is recommended hence service availability and access in and outside school needs to be addressed along with better nancial support for families. Conclusion: These ndings mean that the intervention program was effective in reduction of mothers stress of children with ADHD.

P-31-06 The efcacy of stress coping skills training on parenting stress of mothers of children with ADHD A. Beh-Pajooh*, A. Motevali-Poor * Tehran, Iran Objective: The purpose of the present study was to examine the efcacy of stress coping skills training on parenting stress of mothers of children with Attention Decit Hyperactivity Disorder (ADHD) Method: Twenty four mothers that their children were diagnosed with ADHD were matched and randomly assigned to experimental and control groups. Quantitative Electroencephalography and Parenting Stress Index as well as Checklist of ADHD were utilized to measure mothers stress and ADHD. Then, the experimental group participated in an intervention program in 11 sessions (60 min each). The hypothesis was tested by using analyses of covariance (ANCOVA). Results: The results indicated that stress coping skills training on parenting stress of mothers of children with ADHD were signicantly effective and mothers of the experimental group showed signicant reduction (p\0/01) on parenting stress. This reduction was found in the following subscales: demandingness, restrictions of role, depression and social isolation.

P-31-08 Relationship between parents age and parenting styles in parents of children with Attention Decit Hyperactivity Disorder. T. Baghani*, Z. larijani, P. Golkarian * Tehran, Iran Objective: This study examines the relationships between parents age and parenting styles to determine if there is any relationship between three parenting styles and parents age or not Method: Thirty three mothers of children with Attention Decit Hyperactivity Disorder, ADHD, (childrens mean age: 8 years) who were chosen based on convenience sampling participated in the present study. The diagnosis of ADHD was established through clinical interviews with parents according the criteria in DSM IV- TR. They completed Baumrinds parenting styles scale and a demographic scale. Correlational design was used to show the relationship between variables. Results: results Indicate signicant correlation between parents age and parenting styles. There is a positive relationship between parents age and applying permissive style (r= .47, sig .01, n= 33), while there is no relationship between authoritative also authoritarian style with parents age. Conclusion: These results suggest that older parents apply permissive style.

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202 P-31-09 ADHD service reforms-impact of ADHD nurse specialist role in improving outcomes in ADHD management. R. Beets*, I. Takon, A. Galloway, W. McClaughlin * Welwyn Garden City, United Kingdom Objective: To review the impact of ADHD Nurse Specialist Role in improving services for children seen in an ADHD Specialist Clinic in East Hertfordshire Method: The ADHD Nurse Specialist was appointed in June 2008. Prior to this, the service was run in a Joint clinic by the Paediatricians and Child Psychiatrist. There were major gaps in the service identied from a previous service Audit done in 2007 and Parent satisfaction audit in 2008. The gaps included poor Liaison between ADHD Clinic and Schools, long waiting times for initial assessments and review appointments, lack of clinician time to respond to queries and concerns from parents and insufcient time for Clinicians to carry out school observations where required. The ADHD Specialist Nurse kept a log of her clinical activities and feedback was obtained from service users which included parents, children carers, school staff and staff from other agencies involved in managing children with ADHD Results: The ADHD Nurse carried out 45 school observations on children referred for ADHD in 1 year where the diagnosis was unclear at initial assessment. A Nurse led ADHD Clinic review was started and has helped to reduce the waiting list signicantly for new and follow up patients. Telephone consultations of 10-20 calls per week, dealing with repeat prescriptions, maintaining ADHD Database, Training for Educational Staff and School Nurses, School Liason and Attendance at Professional meetings were other activities carried out by the ADHD Nurse. The ADHD Nurse has been actively involved in Service developments and ADHD Research. Conclusion: The ADHD Specialist Nurse role has resulted in signicant service improvement in delivery of ADHD Services in East Hertfordshire. This has also improved the outcome for Children with ADHD and their families. There is a need to develop more ADHD Specialist Nurse roles to help address the increasing pressure on ADHD Services. Z. S. Larijani*, T. Baghani, L. Azhdehfar * Tehran, Iran Objective: This study examines the relationships between marital satisfaction and anxiety to determine if there is any relationship between anxiety and marital satisfaction or not. Method: thirty ve mothers of children with Attention Decit Hyperactivity Disorder, ADHD, (childrens mean age: 8.1 years) who were chosen based on convenience sampling participated in the present study. The diagnosis of child ADHD was established through clinical interviews with parents according the criteria in DSM IV- TR. They completed the Enrich marital satisfaction inventory and Beck Anxiety Inventory (BAI). Correlational design was used to show the relationship between marital satisfaction and parenting styles. Results: Results indicate signicant correlation between marital satisfaction and anxiety. There is a negative relationship between marital satisfaction and anxiety(r= -.61, sig .01 n=35). Conclusion: Results indicate that the higher marital satisfaction associated with lower anxiety. P-31-12 Relationship between marital satisfaction and anxiety in mothers of children with Attention Decit Hyperactivity Disorder

Saturday, 28 May 2011, 14.3016.00 P-32 Pathophysiology: Children and adolescents III
P-32-01 Characteristics of learning planning functions of students with learning disabilties with and wihtout ADHD B. Shrieber*, O. Hetzroni * Hertzeliya, Israel Objective: a. To identify characteristics of learning planning functions of students with LD, studying in postsecondary institutions, and to investigate if these functions differ from those of students without LD. b. To explore the characteristics of students with LD Method: Subjects: 415 students with and without LD with and without ADHD from 9 postsecondary institutions in Israel. The subjects lled self- report questionnaires. Diagnostic tests were collected from students with LD and analyzed, using 8 measurements of cognitive functions: Fluent reading, phonological awareness, spelling, garpho-motor, working memory, visual memory, math and ADHD (attention data). Results: Three learning planning functions and implementation components were identied: Motivational factors, planning functions and planning implementation functions. 1. Students with LD reported lower levels of functioning in all learning planning functions, than their peers without LD. 2. Analysis revealed 4 clusters: Verbal LD, working memory, non-verbal LD and complex LD. The attention data were low in all four clusters. The lowest measurements of attention were found in the cluster representing non-verbal and complex proles. 4. No differences or connections were found between planning functions and the 4 proles of LD. Conclusion: The study found that students with LD with and without ADHD confront difculties in planning during their study. It claried the different factors that characterize the learning difculties of students with LD. These ndings highlight the existing relationship between attention and non-verbal cognitive functions. We can learn from that that adult with LD, especially those with non-verbal LD, characterized also with attention difculties. Motivational factors and awareness to

P-31-10 Children with ADHD and bullying G. Buljan Flander*, M. Lokas, T. Manovic * Zagreb, Croatia Objective: In the period from 2005 to 2010 Child Protection Center Zagreb has multidisciplinary treated 257 children with symptoms of ADHD. Results of treatment indicate that some of those children were also exposed to bullying. Method: The aim of this paper is to determine if there are statistically signicant differences between children with ADHD who have been violated by peers and children without the experience of bullying, but with the same diagnosis (ADHD) compared to the children who have been exposed to bullying, but do not have the diagnosis of ADHD. Results: We will review differences between them through following variables: age, gender, family features, academic success, some characteristics of childrens psycho-social functioning. Conclusion: The limitations of this research conducted on the clinical sample of children having been diagnosed and treated in an institution specialized for psycho-traumatized children, do not enable making conclusions about general population. However, the obtained results can still be useful in further clinical work with children who have similar difculties.

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203 learning strategic might explain the ability of the students to compensate their learning difculties and to succeed in their study. from Cz, and during the second phase from Fz-Pz. Statistical analysis was done by SPSS 10.0. Results: We have observed statistically signicant shortening of latency of later response like P3 (beyond .001 level: Z=-3.517, p\.0001) in study group compared with controls. Besides the increasing of amplitude of P3 in study group was also obvious (beyond .001 level: Z=-3.546, p\.0001). The amplitude and latency of earlier response like N1was not changed after neurofeedback therapy considering that it was absolutely non effective for this component Conclusion: According to our results we have concluded that neurofeedback can not affect on the earlier ERP response like N1 which is correlated to simple recognition of auditory stimulus. As for later response neurofeedback was effective for P3 which reects process of selection of action and decision making which consist one of the most important aspects of executive functioning frequently affected in ADHD children.

P-32-02 Neuropsychological assessment in a Portuguese sample of children with Attention Decit Hyperactivity Disordercombined subtype (ADHD-C) C. Alfaiate*, M. R. Simoes, J. B. Fernandes * Coimbra, Portugal Objective: Evaluate the impact of Attention Decit Hyperactivity Disorder-combined subtype (ADHD-C) on neuropsychological functioning. Method: 30 children with ADHD-combined subtype (ADHD-C) were evaluated with the Coimbras Neuropsychological Assessment Battery (BANC). The results were compared with the results of a typically developing comparison group of 30 children, all matched on age, gender, geographic area and parents education. Results: As far as average overall cognitive ability (WISC-III, RCPMT), the results in specic neurocognitive functions show signicant impairment on tasks of domains evaluated with BANC: memory, executive functions, attention and language. Major differences were nd on measures of visuo-spatial immediate and delayed memory, planning, sustained attention, divided attention and rapid naming, with moderate to large effect sizes (Cohens d). No signicant differences were found on measures of selective attention and verbal uency. Conclusion: The results seem to validate the clinical usefulness of the Coimbras Neuropsychological Assessment Battery in ADHD-C childrens evaluation.

P-32-04 Attention Decit Hyperactivity Disorder: Event-related brain potentials in test go/nogo E. Yakovenko*, I. Nikishena, L. Chutko * St. Petersburg, Russia Objective: The world-wide increase in information load and cases of ADD in children make the research of possible corrections of these conditions almost urgent. During the last few years, the RAS team of researchers made several attempts to use event-related potentials of the brain as objective criteria of infringement of attention in humans. The purpose of the given research was the study of the dependence of the component P300 amplitude on the action connected with the suppression and also the evaluation of the quality of the test performance in paradigm GO/NOGO at children with ADHD. Method: 140 children with ADHD aged 10-15 years participated in the study. The GO/NOGO task consisted of 480 pair stimulus low low tone (GO) and low - high tone (NOGO). For each subject the quantity of misses of signicant pairs stimulus (an error of carelessness) and the quantity of the false pressing of the button was counted up at presentation insignicant pairs (the errors connected with impulsiveness). Results: The amount of errors in task GO/NOGO in the group of children with ADHD was more signicant than that in the group of healthy children. Signicant decrease in the P3 component amplitude of GO and NOGO in group of children with ADHD in comparison with healthy children was detected. Conclusion: The design of the task and a plenty of children surveyed by us with ADHD Have allowed to reveal correlation between amplitude of a component of involving in action and amount of misses of signicant pairs stimulus, and also amplitudes of a component of suppression of action and amount of false pressing insignicant pairs stimulus. It is necessary to note, that parameters of amount of misses and false pressing it is signicant correlate among themselves. Work is supported by the grant: HI-3318.2010.4

P-32-03 Inuence of EEG biofeedback on ERPs in Attention Decit Hyperactivity Disorder children S. Bakhtadze*, M. Janelidze, N. Khachapuridze * Tbilisi, Georgian Objective: Assessment of Attention Decit Hyperactivity Disorder (ADHD) is based mostly on the various questionnaires and neuropsychological tests. The role of neurometric tools for this purpose is still ambiguous. Although there are several papers concerning neurophysiologic parameters of ADHD children including event-related potentials (ERPs) but their role in the assessment of such children is disputable. As for treatment according to different guidelines the most effective method for the treatment is various drugs (especially psychostimulants) causing several adverse events including growth suppression, insomnia et al. This last fact promotes scientists to seek alternative, non-pharmacological method of treatment. The most popular non-pharmacological approach is EEG biofeedback (neurofeedback). In spite of numerous papers concerning the effectiveness of neurofeedback in ADHD children its impact on the neurophysiologic prole of such children including ERPs is not clear. Method: We have prospectively examined 18 children with ADHD before- and after 30- sessions of neurofeedback therapy and 22 without treatment as control ones. The assessed parameters of ERP were timing (latency) and amplitude. EEG during ERPs was recorded from Cz-A1 derivation as it is considered that amplitude is maximal in this area. We have assessed two components of ERPs: earlier (N1) and later (P3). As a task for the registration of P3 we have chosen auditory oddball paradigm. Neurofeedback was conducted over a period of 6 weeks. Training was divided into two phases: rst phase implies enhancement of SMR rhythm. In the second phase we have used beta/theta training. During the rst phase EEG was recorded

P-32-06 Neurocognitive functioning in children with ADHD M. Mehta*, P. Sinha, R. Sagar * New Delhi, India Objective: To assess neurocognitive functions in children diagnosed as ADHD. Method: 30 children diagnosed as ADHD and 30 normal children in the age range of 6 to 14 years, both male and female children were assessed for neurocognitive functions. The assessment was made for

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204 intellectual functions, memory and executive function test. Intelligence was assessed on Indian adaptation of WISC, Memory was assessed on verbal N Back test, Visual N Back test. Executive functions were assesssed on Design Fluency test, Porteus maze test, Wisconsin card sorting test and Stroop test for children. Results: ADHD children had decits on the sub-scales of arithmatics and digit span. They had problems in working memory, response inhibition and cognitive exibility.Children with ADHd had problem in planning and maintaining set. Due to the decits in neurocognitive functions these children had academic problems and behavioural problems. Their adjustment in school was not satisfactory. Conclusion: Neurocognitive functioning has manifestation in clinical symptoms and outcome of ADHD. Management strategies should be planned according to the neurocognitive dect in the child. Method: Participants consisted of 55 children ranging from age 6 to 16 years old. 34 children with ADHD and 21 siblings without ADHD, referred to participate in this Brazilian project on ADHD endophenotypes. Diagnostic Procedure Parents of the participants were interviewed by research psychiatrists using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (KSADS) module for ADHD and a semi-structured interview based on DSM-IV criteria in order to evaluate other comorbidities (P-CHIPS). Statistical Analysis We used MANOVA with one between group factor and one within subject factor of repeated measures of blocks of trials to evaluate if children with ADHD and their siblings made faster errors than their average correct response and if there were differences in the number of errors and intra-individual coefcient of variability (ICV) using independent-samples t test. Dependent Variables We derived from the stop signal paradigm the following variables: Number of errors on go trials, Intra-individual coefcient of Variability (ICV), response speed (MRT) and response speed of errors (MRTE). Results: Groups did not signicantly differ in any of the measures used. There were signicant differences between the MRT and MRTE for both the ADHD (MRT 501,38 102,07 MRTE 408,03 104,18 P\0,001) and the non-affected siblings groups (MRT 486,51 107,24 MRTE 423,39 164,18 P\0,001). Conclusion: Our results suggest that children with ADHD do not differ from their non-affected siblings and may be highly similar in response speed, accuracy and variability measured by the Stop Signal Test.

P-32-07 ADHD symptoms modulates the use of spatial and stimulus-response learning and memory strategies in 8-year old children P. Robaey*, S. McKenzie, R. Schachar, M. Boivin, G. Dionne, V. Bohbot * Ottawa, Canada Objective: Hippocampal-based spatial and nucleus caudate-based stimulus-response strategies are used in parallel in spatial navigation learning and memory. School-age children use preferentially spatial learning. As a fronto-striatal dysfunction has been proposed in ADHD, this study aimed at testing the hypothesis that ADHD-type behaviors would reverse this preference. Method: 299 children (8 years of age) on the 4-on-8 virtual maze adapted to children (a4/8VM) paradigm in order to investigate spontaneous navigational strategies in children with ADHD. They always started a trial at the center of a virtual 8-arm radial-maze that contained 4 objects that had to be located among the 8 open arms. They were asked to retrieve all four objects from the rewarded arms. Participants were given at most 13 trials to learn the locations of the rewarded arms to criteria. To reach criteria participants were required to have completed three out of the last four trials without error. After criterion was reached, a probe trial whereby all landmarks were removed was administered in order to dissociate the children who used landmarks from those who did not. In addition, a debrieng allowed classifying the strategy as spatial or stimulus-response. Results: We found a signicant interaction between the number of ADHD symptoms and learning strategy during our virtual navigation task. Displaying a few ADHD symptoms, especially hyperactive symptoms decreased the performance in learning trials, but improved performance on the probe trial. Conclusion: These results suggest that the presence of ADHD symptoms shifts the strategy toward a caudate dependent response strategy at the expense of hippocampal-based spatial strategies. Repetition and reward based teaching strategies, which are hallmarks of response learning, are likely the most effective in children exhibiting ADHD symptoms and would allow them not losing their way especially during transitions.

P-32-09 The role of motor control deciencies in adapting multicomponent visual-motor tasks in children with Attention Decit Hyperactivity Disorder C. Yakut* * Lock Haven, USA Objective: The goal of this study is to explore motor control deciencies that may hinder adapting a multi-component visual-motor task in children labeled with ADHD. Method: 23 subjects, 7 female (age 8-11 yrs.) directed a cursor onto a circular target on a monitor as quickly as possible. A joystick directed the cursor movements having either position or velocity control order and compatible or incompatible mapping. Compatibility means that the directions of the control (arm movement) and display (cursor) movements are in the same direction (parallel) while incompatibility indicates that the direction of the control and display movements go in opposite directions when subjects face the computer. In position control, the joystick positions the cursor: A single unidirectional movement will cause a single unidirectional output motion. In velocity control, the position of the control determines the velocity of the controlled object: Bidirectional movement is needed to cause a unidirectional output motion on the screen. Subjects rst performed Position Compatible (PC) task for 80 trails (10 Blocks) and switched to Velocity Incompatible task (VI) for another 80 trails (10 Blocks). The total number of trials for both PC and VI tasks were 160 trials (20 blocks). Two dependent variables Homing Time (HT) and Cursor to Target Distance (CDT) were used to measure the performance of each subject. Homing Time, which indicates a combination of target acquisition and re-acquisition time, is an interval between rst and nal entry into the target area. It measures the subjects capabilities of controlling the ne movements during the last phase of movement execution to complete each trial. Cursor to Target Distance indicates the distance of cursor travel between the starting

P-32-08 Cognitive performance measured by the stop task in children with ADHD and their non-affected siblings R. Suwwan*, G. Coutinho, J. A. Sergeant, P. Mattos * Rio de Janeiro, Brazil Objective: To evaluate if there are any differences in response speed, speed of errors, accuracy and intraindividual variability between children with ADHD and their non-affected siblings?

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205 point (center of the monitor) and the target. It measures ne adjustments and efcient movement controls. Results: There was a statistically signicant difference for HT and CTD between ADHD and none-labeled children. ADHD had significantly slower HT (1193 ms versus 757 ms) than none-labeled (p\.0003). CTD was signicantly longer in ADHD (165 mm versus 144 mm) than none-labeled (p\.0000). Conclusion: Children labeled with ADHD are limited in their ability to adjust the speed of responding when a task requires a rapid response to a stimulus. The poor performance of HT and CTD in children labeled with ADHD may indicate that poor manual motor coordination may be associated with ADHD. In summary, children labeled with ADHD require more time and practice than non-labeled (normal) children to adapt to a multi-component complex visual motor task. replicable ndings. This study addresses two questions that are of fundamental importance to our understanding of the phenomenon and, potentially, ADHD. First, what is the nature of increased ISV in ADHD? Second, what is the electro-cortical signature of ISV in ADHD? Method: Twenty-ve healthy children (aged 11-12 years) and 26 patients with ADHD (aged 11-12 years) took four visual choice reaction time tasks of the 0-back and 1-back type and using jittered (2.0-3.0 s) versus constant (2.0 s) SOAs (2 9 180 trials, 25% targets each). The EEG was recorded from 64 channels using active electrodes and DC ampliers (sampling rate 500 Hz, DC-250 Hz; Brain Products, Munich). Independent Components Analysis (ICA) was employed for artifact correction and single-trial ERP analysis based on Independent Components Analysis (ICA). We derived a differentiated set of RT parameters from our tasks which reect different facets of ISV (e.g., moment-to-moment uctuations, periodicities etc.) and related single-trial RTs with single-trial independent components. Results: While patients and controls did not differ in mean RT, patients responded more variable and error-prone than controls. We found independent components that correlated positively or negatively with single-trial RT in both groups. These correlations, however, were of greater magnitude and showed an earlier onset in controls. Conclusion: The present study demonstrates that ICA-based singletrial analyses can be used to discover brain-behaviour relationships and map their temporo-spatial course with high temporal precision. Furthermore, the coupling of neurophysiological and behavioural responses seem to be weaker and start later in patients with ADHD.

Saturday, 28 May 2011, 14.3016.00 P-33 Pathophysiology: Children and adolescents IV

P-33-01 Lexical processes in children with Attention-Decit Hyperactivity Disorder: A preliminary event-related brain potentials study P. Gonzalez-Perez*, A. Dominguez, D. Beltran, S. Hernandez, A. Quintas, L. Artiles * La Laguna, Spain Objective: ADHD children are diagnosed in relation to some degree of inattentiveness, impulsivity and hyperactivity (DSM-IV-TR, 2002). These decits could be inuencing the academic performance and specically the reading processes at the lexical level. This work is an exploratory study to know the pattern of behavioral performance and brain activity in visual word recognition. Method: To reach this goal a Lexical Decision Task was administered. Lexicality (word vs pseudoword) and Lexical Frequency (high vs. low) were the main variables registered in 2 groups of ADHD children between 8 and 13 years old, classied as poor phonological decoders (pseudoword reading Pc\25) and good phonological decoders (Pc[50), and 1 group of healthy children. All the children had a normal IQ (range [[85,\115]) and show right-handed preference. Results: ADHD readers perform slower reaction times than control group at lexical decision task. All three groups responded slower to pseudowords than words but high lexical frequency words are recognized faster than low frequency words only by control and good ADHD readers and not by poor ADHD readers. In relation to the psychophysiological variables the good and poor phonological decoders seem differ at the N400 component. Conclusion: N400 could be a marker for the lexical access and semantic word integration, that allows discriminating reading abilities in ADHD.

P-33-03 Inherited Pre-frontal cortex (PfC) disinhibition in Attention Decit Hyperactivity Disorder (ADHD) adolescents offspring of Alcohol Use Disorder (AUD) parents M. Habeych*, R. Tarter * Pittsburgh, USA Objective: To extent the hypothesis of a dysregulation on PfC inhibitory functions in young adolescents with ADHD, offspring of AUD parents. Method: Twelve ADHD subjects and 55 control adolescents aged 10-12, were evaluated on percent of pro-saccade errors, rst saccade latency (ms), anti-saccade peak velocity (degrees/sec), and gain (percent to target) were evaluated using an infrared scleral reection system mounted on a spectacle frame used by the subject, connected to an eye tracking monitor with precision of 0.1 and range of 30 degrees. Horizontal eye movements were digitized at 256 Hz using an A/D converter. EOG was registered and accuracy of the subjects eye movements monitored in real time. WINDAQ and WINSAC software packages were used. Continuous variables were compared using the student-t, and percentages chi-square tests. Results: No differences were found on parents, subjects, or antisaccade variables under any of the three conditions (zero, gap or overlapping of the 2 eliciting visual stimuli) tested, between groups of parents with AUD (N=67) and without (N=12). However, signicant differences were found on the anti-saccade parameters between groups of subjects with (n=12) and without (n=55) ADHD diagnosis from the group of parents with AUD. Percent of prosaccade errors under the zero (61.1 23.51 vs 44.9 21.41; t=-2.4; p=0.02) and gap conditions (75.67 19.13 vs 58.06 22.25; t=-2.62; p=0.01), as well as, anti-saccade peak velocity under the zero condition (1311.46 359.43 vs 253.89 132.55; t=-2.24; p=0.03) were found.

P-33-02 Electro-cortical correlates of intra-subject variability in Attention Decit Hyperactivity Disorder (ADHD) C. Klein*, B. Feige * Freiburg, Germany Objective: Increased intra-subject variability (ISV) of manual reaction times gures prominently in the literatur on Attention Decit Hyperactivity Disorder (ADHD) as one of the most robust and

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206 Conclusion: Signicant differences on anti-saccade variables only when comparisons between ADHD? and groups of subjects, offspring of AUD? parents, were found. This predisposition, probably genetically transmitted, and expressed in ADHD and AUD through a fronto-striatal dopaminergic alteration, is probably shared by both conditions. the instruction stimulus of whether to win or lose was presented. After presentation of a hand gesture stimulus, participants were asked to make a hand shape to win or lose according to an instruction stimulus. EEGs were recorded from 30 scalp locations and were averaged at the onset time of the instruction stimulus and gesture stimuli. The behavioral measures to reaction time and accuracy and event-related potentials (ERPs) to cued P2 and P3 were collected. Results: The performance in children with ADHD was characterized longer reaction times and higher error rate on lose condition rather than typical development children. In children with ADHD, the latency on cued P2 for lose condition was longer than that for win condition. Additional, the amplitude of cued P2 and P3 for lose condition were smaller than that for win conditions. On the other hand, in typical development children, no difference were observed in any component regardless in win or lose condition. Conclusion: The present study suggested that children with ADHD have difculties in orienting of attention under the condition of high conict (i.e. lose condition). So, they might use ineffective inadequacy of informative cue and conict resolution fully in conict processing. Moreover, these results might suggest that anterior cingulated cortex (ACC) and dorsolateral prefrontal cortex (DLPFC) dysfunction in children with ADHD.

P-33-04 Cortical inhibition and facilitation: preliminary results of a comparison between children with ADHD and autism A. Kroger*, T. Jarczok, C. M. Freitag, S. Bender * Frankfurt, Germany Objective: Hyperactive behaviour in children with ADHD can be explained to some extent by reduced cortical inhibition of the primary motor cortex. Neuronal correlates of inhibition and excitability of the motor cortex can be assessed with transcranial magnetic stimulation (TMS). A reduced intracortical inhibition (short interval intracortical inhibition, SICI) in children up to 15 years with ADHD was shown in paired pulse designs in several studies (Moll et al. 2000, 2001; Buchmann et al. 2007). But all those studies only assessed motor evoked potentials (MEP). Synchrone EEG and TMS measurement allows to assess TMS evolved cortical processes. A known electroencephalographic response to TMS is the N100. This N100 component was suggested to reect an inhibitory response (e.g. Bender et al. 2005). In this way in a recent study a reduced N100 over the stimulated motor cortex was found in patients with ADHD (Bender et al., in preparation). But up to now, there are only a few studies assessing both EEG and motor evoked potentials (MEP) after TMS in those populations. Hyperactive behaviour is also common in children and adolescents with autism. Currently, there are no published TMS studies, investigating cortical inhibition and facilitation in patients with autism. In this study we want to compare children with ADHD, autism and a healthy control group with regard to cortical inhibition and facilitation. Method: Children with ADHD or autism, aged 8 to 15 years of age and a matched healthy control group were included in this study. All participants were free of any psychoactive medication at the time of assessment. Children treated with stimulants had to be free of this medication for at least 24 h. Further, children with epilepsy, tic disorder, compulsive obsessive disorder or psychotic disorder were excluded. Motorcortical modulation was tested with TMS paired pulse protocols employing an inter-stimulus interval of 3ms, 10ms and 100ms to test SICI, short interval intracortical facilitation (SICF) and long interval intracortical inhibition (LICI). MEP and 64-channel EEG were recorded. Results: The experiments were not nished at the time of abstract submission. First results will be presented and discussed at the conference.

P-33-06 Reaction time variability and cognitive arousal in Attention Decit Hyperactivity Disorder: A cognitive-EEG investigation C. Cheung*, G. McLoughlin, F. Rijsdijk, P. Asherson, J. Kuntsi * London, United Kingdom Objective: Attention Decit Hyperactivity Disorder is associated with increased reaction time variability (RTV). One explanation for this nding is that individuals with ADHD have difculties regulating arousal. EEG ndings also suggest an association between ADHD and underarousal (increased theta and alpha power). This study aims to investigate the association between increased RTV and EEG-indexed arousal in ADHD, by measuring EEG power and RTV simultaneously. By comparing ADHD probands to their unaffected siblings and controls, we can further examine shared familial effects on these processes and ADHD. Method: 15 probands with ADHD combined subtype, 11 unaffected siblings (USIB) of the probands and 20 controls (UC), aged 11-23, completed a baseline RT task (fast task) with simultaneous EEG measurement. Absolute power in the theta (4-7 Hz), alpha (7.5-12 Hz) and beta (15-18 Hz) bands was analysed separately in the frontal, central and parietal regions using the Fast Fourier Transform. Results: A signicant main effect of group emerged on RTV (p\0.001), theta (frontal and central; p\0.05), alpha (all regions; p\0.05) and beta (frontal; p=0.01). Compared with UC, ADHD group showed increased theta (frontal; p\0.05), alpha (all locations; p\0.05) and beta (frontal; p\0.05) activities, and both ADHD and USIB exhibited higher RTV (p\0.01). RTV was correlated with theta frontal (r=0.33, p\0.05) and central (r=0.31, p\-.05) activity, and with frontal alpha activity (r=0.31; p\0.05). Other comparisons were not statistically signicant. Conclusion: We observed EEG-indexed underarousal in the ADHD group during a RT task and an overall association between increased RTV and increased theta and alpha power. The ndings are consistent with the view that increased RTV in ADHD reects underarousal. We will investigate this further in a larger sample, by exploring EEG changes over time. A larger sample will also enable a more detailed investigation of the familial effects on these processes.

P-33-05 Orienting of attention and interference control in children with Attention Decit Hyperactivity Disorder A. Masumi*, S. Okazaki, H. Maekawa * Tsukuba, Japan Objective: We examined orienting of attention and interference control in children with or without symptoms of Attention Decit Hyperactivity Disorder. Method: 10 children with combined-type ADHD aged 8-13 years and age-matched 14 typical development children performed a rockpaper-scissors (RPS) task. In this task, prior to hand gesture stimuli,

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207 P-33-07 Error and reinforcement processing in medicated and medication-free children with ADHD: An electrophysiological study Y. Groen*, O. Tucha, B. Wijers, M. Althaus * Groningen, The Netherlands Objective: Current explanatory models of ADHD suggest abnormal reinforcement sensitivity, but the exact nature of this decit is unclear. In the present study we adopted an electrophysiological approach to gain more insight into the reinforcement sensitivity of children with ADHD. Method: Three groups of children performed a simple selective attention task: a medication-free ADHD group (ADHD-free), a methylphenidate-treated ADHD group (ADHD-mph), and a normally developing control group (NC). The task was performed under three reinforcement conditions: no feedback, win and loss. Both the win and loss condition provided positive and negative feedback that was contingent upon responses. In the win condition children started with 0c and gained 1c after correct responses, whereas in the loss condition they started with 80c and lost 1c after error responses. Electroencephalogram Event Related Potentials (ERPs) time-locked to errors and reinforcement were computed. Results: All groups performed more efciently in the win and loss condition than in the no feedback condition. Regarding the ERPs, there was no indication of a) reduced sensitivity to positive reinforcement in the ADHD-free or ADHD-mph groups, or b) reduced error monitoring in the ADHD-free group. However, we found a trend to signicance (p = .08) for enhanced processing of negative feedback in the win condition for ADHD-free group (this concerned a frontally located N2-effect). The ADHD-mph group showed signicantly enhanced monitoring activity of responses and reinforcement compared to the ADHD-free and NC groups (this concerned enhanced Error/Correct Related Negativity and Feedback Related Negativity). Conclusion: In a cognitive task with highly predictable and consequent reinforcement, ADHD children without medication show no convincing aberrant reinforcement sensitivity. However, they appear somewhat more sensitive to negative reinforcement when they are in the winning mood. Methylphenidate does have a generally stimulating effect on response monitoring and reinforcement monitoring in children with ADHD. Bretherton et al., 1985) and the Adult Attachment Projective (AAP; George et al., 1997). The second salivary cortisol level was assessed in boys after the Story Stems, representing an attachment specic stressor. Results: As we predicted, boys with ADHD symptoms had signicantly lower cortisol levels in comparison to healthy boys prior to the session. Surprisingly, their mothers showed a similar pattern, with cortisol levels being signicantly lower than in the control group (T 2.716, p\0.05). We found a highly positive correlation between cortisol levels in mothers and their children, but only in the ADHDGroup (Pearson 0.416, p\0.05). The stress reaction to Story Stems in boys was not only inuenced by their own attachment style, but by the attachment style of the mother as well. This result was also restricted to the ADHD-Group. Conclusion: According to our preliminary results, boys with ADHD seem to be very sensitive in their stress regulation to factors related to the attachment gure. These results could play an important role for future therapy concepts and need further research.

P-33-09 EEG abnormalities in children diagnosed with ADHD by the time of ADHD assessment D. Socanski*, A. Herigstad * Stavanger, Norway Objective: To investigate the occurrence of EEG abnormalities in children diagnosed with Attention Decit Hyperactivity Disorder (ADHD) and their relationships to previous history of epileptic seizures (ESz) and ADHD subtype by the time of ADHD assessment. Method: A retrospective study of 617 children (aged 5-14 years, mean, 9.4?2.5) who were diagnosed with ADHD at our Department, between January 2000 and December 2005. Of these, 517 children (82% male) had performed one routine EEG at baseline. EEG ndings were divided into two groups: EEG with non epileptiform abnormalities (EEG-non-EA) and EEG with epileptiform abnormalities (EEG-EA). Clinical characteristics of these two groups; sex differences, age at assessment, previous history of ESz and ADHD subtypes were analyzed. Results: The groups did not differ regarding age, but patients with EEG-EA were more often females. The distribution of ADHD subtype (combined or inattentive) differed between the two groups, with the inattentive group being more common in EEG-EA regardless previous history of ESz compared to EEG-non-EA. 14 patients had previous history of epilepsy, 12 of them had EEG-EA. EEG-non-EA were registered in 51% patients, while EEG-EA in 7.5% (39 cases). Of these 39 cases, 27 (69%) had no previous history of ESz. 11% patients with EEG-non-EA had also EEG-EA, while 2% cases with normal background activity on EEG had EEG-EA. Conclusion: Children diagnosed with ADHD had more often EEG abnormalities (both EEG-non-EA and EEG-EA) than normal school aged children. The majority of children with EEG-EA had no epilepsy co-morbidity, and a careful diagnostic consideration is warranted. ADHD predominantly inattentive subtype was more common in children with EEG-EA regardless previous history of ESz.

P-33-08 Boys with ADHD and their mothers: What can we learn from the neuroendocrinology? N. Vuksanovic*, C. Kern, K. Zeber, M. Bidlingmaier, J. Borns, K. H. Brisch * Munich, Germany Objective: From the previous research we know that in healthy children the stress response, especially to emotional and attachment specic stressors, depends on attachment style of the child, which is highly predicted by the attachment style of the mother. Since children with ADHD seem to show different stress reaction patterns and decient emotional self-control, the aim of our study was to investigate the factors inuenced by the attachment gure, mostly mother, and their impact on this neuroendocrinologic regulation in boys with ADHD. Method: In a cross-sectional study salivary cortisol levels were measured in a group of boys with ADHD symptoms (N=36, age 4-9 yrs), in a control group (N=34, age 4-8 yrs) as well as in their mothers. Boys and their mothers were assessed at the level of attachment representation with Story Stems (Emde et al., 2003,

P-33-10 Classication of ADHD subtypes using independent ERP components M. Aguilar*, J. Gomez-Amor, E. Herrera-Gutierrez * San Pedro Del Pinatar - Murcia, Spain Objective: Research neuroscience groups have attempted to localise the side of the core brain decit shared in common by ADHD

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208 patients, in many different places and at different times. Multiple causal pathways were found to explain the behavioral changes of ADHD children each mediated by different constellation of brain dysfunction. In this work, our aim was to identify ADHD subtypes using independent ERP components. Method: Two groups of children (150 ADHD and 150 controls), between 7 and 16 years and sex matched, took part in this research. We collect 300 individual ERPs. They performed a visual two stimulus Go/Nogo task (VCPT). ERP responses were decomposed into functional specic independent components using an independent component analysis algorithm (ICA). The peak-picking algorithm selects a set of ERP components features. The accuracy and precision of this method in this type of signal was high than 94%. Cue processing problems in ADHD subjects with difculties in preparation for the target has been reported, and we analyzed responses to stimulus two (S2) of exogenous and endogenous aspects of cue processing, in different topographies of the brain cortex. Results: The set of features consisted of latency and amplitude measures in specic time windows, which were collected from different ERP components. The independent ERP components were a sensory, an executive functions and a novelty one. Eleven components were selected based on their total power in response to S2 of the 400 VCPT trials in a specic time interval. The cortical source or generators of independent components give us the names of the components. Conclusion: In this study, we correlate the lag in brain development of ADHD children with six electromagnetic dened endophenotypes focused on independent ERP components that are in connection with a dysfunctional connectivity between different brain cortex networks. The six groups of patients follow different neuro-developmental pathways related to sensory and executive problems expressed by children with ADHD. Conclusion: The primary analysis allow to suppose the children included in ADHD nosology is heterogeneous Its should be related with different neurophysiological mechanisms.

P-33-12 Behavioral and neurophysiological study of attentional and inhibitory processes in ADHD and control children with a continuous performance task S. Baijot*, N. Deconinck, I. Massat, H. Slama, C. Colin * Brussels, Belgium Objective: To compare behavioral and electrophysiological responses recorded in a cued Continuous Performance Task (CPT-AX) performed by children with or without Attention Decit Hyperactivity Disorder (ADHD). Such task enables to examine three different kinds of P300 (ERP component) responses: the so-called Cue P300 (elicited by a preparatory process to a response execution/inhibition), the Go P300 (evoked by attention allocation and by the motor response to the target stimulus) and the Nogo P3 (indexing attention and response inhibition to non-target stimuli). Behavioral observations were hits, reaction times and their standard deviation, omissions, false alarms (associated with inattention and/or impulsivity). Method: Event-related potentials were recorded from frontal, central and parietal sites in 9 children with ADHD and 9 control children while they were performing a CPT-AX task. The children were between 8-to-12 year old and the patients were diagnosed ADHD according to the DSM-IV criteria. ANOVAs were performed on behavioral and neurophysiological (peak and mean amplitudes as well as peak latencies of each type of P300) dependent variables with Group as between-participants variable. Results: Whereas hit rates were about 95% in each group, false alarm responses were signicantly more frequent in the ADHD group than in the control group (mostly those associated with impulsivity). Cue, Go and Nogo P300 peak latencies and amplitudes were not signicantly different between both groups. However, the mean amplitude of the Cue P300 was signicantly smaller than the Go and Nogo P300s in the ADHD group only. Conclusion: The higher rate of false alarms in the ADHD group can be mostly explained by their impulsivity/compulsivity. We argue that the small mean amplitude of the Cue P300 (compared to the Go and to the Nogo P300) in the ADHD group could reect a less effective preparatory process to respond or inhibit an answer, which would explain the higher rate of false alarms in that group.

P-33-11 Study of EEG characteristics in children with Attention Decity Hyperactivity Disorders I. Khachidze*, M. Gugushvili, V. Maloletnev * Tbilisi, Georgian Objective: Importance of ADHD studies are determined by its signicant plenty in the childrens population (2% -21% according to different authors) and by the high extent of social desadaptation developing on this background. At the same time so sizeable data spread in different studies make it clear that no single assessment method of ADHD was denitive. This study aimed to improve the ability to ADHD diagnose using procedures QEEG analysis. Method: The EEG of 294 patients aged 4 to 10 years was studied. EEG signals were digitally recorded using a set of 19 scalp electrodes according to the International 1020 system. For each child, 10 s artifact-free EEG epochs were selected (at rest, with open and closed eyes, during functional exertion). 10-15 fragments for each patient were performed and Fourier transformed to provide absolute and relative power estimates for the delta, theta, alpha and beta bands. The topography of this bands of activity over the convexital brains surface was also analysed. Results: Preliminar analysis of data allows to reveal 4 basic types of EEG alteration children with ADHD: 1. Disorganization of basic EEG rhythmicity - 84.5; 2. Increase of indices of absolute power in the low frequency bands 36.3%; 3. Availability of sharp potentials in alpha/ theta ranks 23.2%; 4. Presence paroxysms at the background hyperventilation 39.3%. This basic patterns of EEG disturbances in different combination may be found in the same patient.

Saturday, 28 May 2011, 14.3016.00 P-34 Pathophysiology: Adults II

P-34-01 Participants with high subclinical ADHD symptoms show reduced suppression in the processing of task-irrelevant stimuli as evidenced by the N170 S. C. Biehl*, A. Niklaus, J. Deckert, M. J. Herrmann * Wurzburg, Germany Objective: Previous studies have shown the N170 to be modulated by stimulus relevance. This process has been hypothesized to be mediated by frontal lobe as well as working memory functioning, both of which might be impaired in Attention Decit Hyperactivity Disorder (ADHD). In our study, we investigated the modulation of the N170,

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209 which was expected to be less pronounced in a group with high subclinical symptoms of ADHD compared to a group with low subclinical symptoms of ADHD. Method: A 32-electrode actiCap system was used to measure 26 participants (nine men; mean age 23.6 years) who were preselected for a high or a low symptom group based on their scores on the Adult Self-Report Scale (ASRS). Participants completed a 1-back task with interfering irrelevant stimuli (faces or houses) in between task-relevant face or house stimuli. The two groups were compared with regard to their N170 peak amplitude (as measured by the electrodes O1/O2) for relevant and high-interfering irrelevant stimuli. Results: We found main effects for stimulus category (F(1,24)=21.038, p\.001) with faces yielding higher mean amplitudes than houses, and for stimulus relevance (F(1,24)=55.353, p\.001) with relevant stimuli leading to higher mean amplitudes than irrelevant stimuli. We also found a signicant interaction of stimulus relevance and ADHD symptoms (F(1,24)=6.729, p=.016): Participants with high subclinical ADHD symptoms showed marginally higher mean amplitudes for irrelevant stimuli than participants with low subclinical symptoms (t(24)=2.045, p=.052). There was no difference for relevant stimuli. Conclusion: The results point to enhanced processing of task-irrelevant stimuli in participants with high subclinical ADHD symptoms. This suppression decit might lead to higher distractibility and in turn impaired task performance, and it is likely to be more pronounced in participants meeting full diagnostic criteria for ADHD. Our results therefore might point to ADHD as a continuous as opposed to a categorical impairment. P-34-03 Increased rightward low alpha asymmetry in adults with Attention Decit Hyperactivity Disorder I. Buyck*, J. R. Wiersema * Ghent, Belgium Objective: Several neurocognitive (Hale et al., 2005) and brain imaging (Durston, 2003) studies support atypical brain laterality in Attention Decit Hyperactivity Disorder (ADHD). Moreover, electroencephalographic (EEG) studies show increased rightward alpha asymmetry in individuals with ADHD (Hale et al., 2009), compared with typically developing individuals. In the current study, brain laterality in the EEG alpha frequency band was evaluated between adults with and without ADHD. Method: 128-channel EEG was recorded in 22 adults with ADHD and 23 adults without ADHD during an eyes closed resting condition. Age and IQ did not signicantly differ between groups. Alpha asymmetry was assessed for nine homologous electrode pairs along the anteriorposterior axis. Repeated measures analyses of variance were used for comparison of lateralization in low alpha (8-10 Hz) and high alpha (1012 Hz) frequency bands between adults with and without ADHD. Results: An enhanced rightward low alpha asymmetry was observed in adults with ADHD compared to adults without ADHD, whereas the groups did not signicantly differ in laterality for the high alpha frequency band. Conclusion: In line with previous research in both children and adults with ADHD, rightward low alpha asymmetry appears to be a feature of ADHD. This might reect abnormal brain-state orientation in ADHD.

P-34-02 Theta/beta ratio is related to approach motivation in healthy controls but not in adults with Attention Decit Hyperactivity Disorder I. Buyck*, R. Wiersema, J. Sidlauskaite * Ghent, Belgium Objective: Several studies have found increased electroencephalogram (EEG) slow wave/fast wave ratios in Attention Decit Hyperactivity Disorder (ADHD). More specically, an increased theta/beta ratio during rest has consistently been reported. It has been suggested that increased theta/beta ratio reects reduced cortical control over subcortically driven approach motivation (Putman et al., 2010). In the current study, the relationship between theta/beta ratio during rest and approach motivation was evaluated both in healthy controls and in adults with ADHD. Method: Eyes-closed resting EEG was recorded in 22 adults with ADHD and 27 healthy controls, matched for age, IQ, and sex. Theta/beta ratio was calculated for frontal, central and parietal sites. Approach motivation was measured by the Behavioural Activation System (BAS) Drive scale (Carver & White, 1994). Repeated measures analyses of variance and correlation analyses were used. Results: Groups did not differ for theta/beta ratio. Theta/beta ratio was found to be signicantly and positively related (most strongly at frontal sites) to approach motivation as indexed by scores on the BAS Drive scale. However, this was only the case for healthy controls, but not for adults with ADHD. Conclusion: In contrast to earlier reports, theta/beta ratio was not found to be increased in adults with ADHD. Theta/beta ratio may reect approach motivation in healthy controls, however results are not supportive for this link in adults with ADHD. Further research is needed on the functional signicance of slow wave/fast wave EEG ratios in healthy controls and adults with ADHD.

P-34-04 Neurophysiological correlates of delinquent behaviour in adult subjects with ADHD N. Meier*, W. Perrig, T. Koenig * Wichtrach, Switzerland Objective: The Attention Decit Hyperactivity Disorder (ADHD) shows an enhanced prevalence in arrested offenders compared to the normal population. The aim of the present study was to investigate whether ADHD symptoms are a major risk factor for criminal behaviour, or whether further decits, mainly abnormalities in emotion-processing, have to be considered as important additional factors that promote delinquency in the presence of ADHD symptomatology. Method: Event related potentials (ERPs) of 13 non-delinquent and 13 delinquent subjects with ADHD and 13 controls were compared using a modied Go/Nogo continuous performance task (VCPT) and a newly developed version of the CPT that additionally requires emotional evaluation (ECPT). ERPs were analyzed regarding their topographies and Global Field Power (GFP). Results: Offenders with ADHD differed from non-delinquent subjects with ADHD in the ERPs representing higher-order visual processing of objects and faces (N170) and facial affect (P200), and in late monitoring and evaluative functions (LPC) of behavioural response inhibition. Concerning neural activity thought to reect the allocation of neural resources and cognitive processing capability (P300 Go), response inhibition (P300 Nogo), and attention/expectancy (CNV), deviances were observable in both ADHD groups and may thus be attributed to ADHD rather than to delinquency. Conclusion: Concluding, ADHD symptomatology may be a risk factor for delinquency, since some neural information processing decits found in ADHD seemed to be even more pronounced in offenders with ADHD. However, our results suggest additional risk factors consisting of deviant higher-order visual processing, especially of facial affect, as well as abnormalities in monitoring and evaluative functions of response inhibition.

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210 P-34-05 Cortical arousal in adults with Attention Decit Hyperactivity Disorder A. Edge* * Johannesburg, South Africa Objective: Dominant electroencephalography (EEG)-based models, which explain Attention Decit Hyperactivity Disorder (ADHD) aetiology in terms of delayed cortical maturation, continue to feature strongly in scientic publications. However, compared to EEG studies in children and adolescents, very little research has been conducted on adults to replicate the ndings. Furthermore, EEG investigations in adult populations yield contradictory ndings. This raises serious concerns about the validity of a neurodevelopmental aetiological model for ADHD. The objective for this study is to ascertain whether there is support for EEG-based models in terms of the developmental lag hypothesis of frontal-subcortical functioning. Hence, this study investigates the nature of cortical arousal in adults with ADHD. Method: The sample consists of 20 adults (10 with ADHD and 10 age- and gender-matched controls) who were recruited by various means from multiple sources. Participants were screened by means of the Adult ADHD Self-Report Scale (ASRS), Burke-Austin questionnaire as well as the Millon Clinical Multiaxial Inventory-III (MCMI-III), and were purposively assigned to groups according to ADHD status. Patterns of cortical activity were measured by means of EEG recording of frontal regions during baseline (eyes open and eyes closed task) and cognitive activation (completion of the Austin Maze task) conditions. The EEG waveform recordings were converted to quantitative data by means of Brain Voyager QX software and were analysed according to nonparametric statistical procedures including the Mann-Whitney U-test and the Kruskal Wallis test. Results: Preliminary ndings in a pilot study have yielded similar EEG results to those found in children. Conclusion: The preliminary results seem to suggest that we need to consider the neurodevelopmental model of ADHD, and at the very least that more empirical studies are needed to investigate the theoretically robustness of this model. amplitude measurements were low, thus supporting the use of an amplitude-independent analysis method. Conclusion: The results support the hypothesis of reduced intracortical inhibition as a correlate of disturbed brain function in adults with ADHD.

P-34-07 Default mode network (DMN) impairments in adults with ADHD and bipolar disorder: Connectivity and variability P. Barttfeld*, A. Petroni, H. Urquina, M. Sigman, M. Cetkovitch, T. Torralva, F. Torrente, S. Baez, A. Lischinsky, F. Manes, A. Ibanez * Buenos Aires, Argentina Objective: Current psychiatric research highlights the comorbidity and shared symptomatology of adult Attention Decit Hyperactivity Disorder (ADHD) and Bipolar Disorder (BD), calling for further research. Electroencephalography (EEG) default mode network (DMN) appears as a good candidate to explore the difference and similitude between both disorders in terms of connectivity: the Castellanos and Sonuga-Barke hypothesis (CSBH) proposes that DMN variability and impairments would explain the neurocognitive prole of ADHD. Besides, the investigation of DMN in BD is scant. Method: Here we used electroencephalography (Biosemi amplier of 128 channels) to assess dynamic brain connectivity in ADHD (8 subjects) and BD (10 subjects) populations as well as in a control group (15 subjects)-, focusing in the low frequency (delta) range, showed to strongly reect the activity of the DMN. All groups were matched for gender, age, handedness, and years of education. Correlations between all pair wise combinations of EEG channels were computed for all subjects with the Synchronisation Likelihood (SL) and after that, measures of Graph Theory metrics were computed. Results: ADHD and BD connectivity maps showed a reduction, broadly fronto-posterior, in the DMN connectivity, being the BD group the one showing higher decrements in connectivity. Interestingly, DMN intrasubject variability was higher (Increased SD of connections) in ADHD compared to controls and BD. Moreover, we reported signicant correlations between connectivity measures and clinical/neuropsychological assessment in both ADHD and BD. Conclusion: To our knowledge this is the rst comparison of DMN in ADHD and BD. Our results suggest that ADHD and BD present an impaired DMN indicative of an abnormal pattern of brain functional connectivity. Consistent with the CSBH, ADHD -but not BD- DMN was more variable than control DMN, suggesting that DMN variability would be a source of disruption during cognitive performance, explaining part of the well known ADHDs RTs and performance variability. Our ndings suggest as well that DMN abnormalities found in ADHD and BD would help to understand the higher rates of comorbidity and shared symptomatology between both disorders, as well as some of their differences.

P-34-06 Assessment of postexcitatory long-interval cortical inhibition in adult Attention Decit Hyperactivity Disorder W. Retz*, E. Gonzalez-Trejo, F. Philipp-Wiegmann, K. Romer, P. Reinert, Y. F. Low, S. Boureghda, M. Rosler, D. Strauss * Homburg, Germany Objective: In order to further examine cortical impairment in adult ADHD patients and to test the hypothesis of a disturbed neuronal inhibition in adults with ADHD, late auditory evoked potentials were measured. Method: By using paired-chirp auditory late responses, we compared 15 adults with ADHD with 15 control subjects, focusing on the inhibition elicited by the stimuli. A time-frequency phase coherence study using the wavelet phase synchronization stability (WPSS) was performed. ADHD was diagnosed according to DSM-IV. All ADHD subjects were without medication and did not suffer from any further axis-I disorder. Results: WPSS analysis revealed an impaired auditory inhibition for ADHD patients for interstimulus intervals between 500ms and 1100ms as compared to healthy controls. By analyzing the WPSS signal (80ms-220ms), mean inhibition of the test chirp was 6% in the ADHD group and 38.5% in control subjects (p=0.018). Moreover, overall smaller amplitudes in the N100 (50ms-150ms) and P200 (150ms-200ms) waves at each interstimulus interval were found (p=0.043 and p=0.024). However, reproducibility indices in the

P-34-08 Cortical decits in emotion processing for faces in adults with ADHD: Its relation to social cognition and executive functioning A. Ibanez*, A. Petroni, H. Urquina, T. Torralva, F. Torrente, E. Hurtado, R. Guex, S. Baez, M. Sigman, A. Lischinsky, F. Manes * Buenos Aires, Argentina Objective: Although it has been shown that adults with ADHD have impaired social cognition, no previous study has reported the brain correlates of adult ADHD for face valence processing. This study looked for behavioral, neuropsychological and electrophysiological

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211 markers of emotion processing for faces (N170) in adult ADHD (13) compared to controls (13) matched by age, gender, educational level and handedness. Method: We designed an event related potential (ERP) study based on a Dual Valence Task (DVT), in which faces and words were presented to test the effects of stimulus type (faces, words or faceword stimuli) valence (positive vs. negative) and compatibility (compatible vs. incompatible word and face valence combinations). In order to identify individual signatures of cognitive functioning in participants with ADHD and controls, a comprehensive neuropsychological assessment was carried out, which included measures of executive functioning (EF) and theory of mind (ToM). Results: Compared to controls, the adult ADHD group showed deficits in N170 emotion discrimination for facial stimuli. These N170 impairments were observed in absence of any decit in facial structural processing, suggesting a specic ADHD impairment in early facial emotion discrimination. In participants with ADHD, N170 emotion processing was associated with performance on an emotional inference ToM task, and N170 from simultaneous stimuli was associated with EF, especially working memory. Conclusion: In summary, this is the rst report to reveal an adult ADHD specic impairment in the cortical discrimination of emotion for faces and an association between N170 cortical measures and emotional ToM and EF.

Conclusion: In normal subjects realization of GO task was accompanied by signicant decrease of 8-10 Hz, increase of 36-47 Hz oscillations activity and excitability in motor areas. In contrast during NOGO task increase of 8-10 Hz, decrease of 36-47 Hz oscillations activity and excitability was detected in motor areas. In ADHD subjects these mechanisms is abnormal. These results demonstrate correlates oscillatory low and high activity with excitation and inhibition processes in cortex.

Saturday, 28 May 2011, 14.3016.00

P-34-09 Electrophysiological correlates of inhibition system in adolescents and adults with different levels of inattention, impulsivity, hyperactivity A. Trembach*, D. Samarskiy, V. Tolokonikova * Krasnodar, Russia Objective: Studies using Transcranial Magnetic Stimulation (TMS) to probe the neural inhibitory circuitry of Attention Decit Hyperactivity Disorder (ADHD) showed conicting results. The purpose of investigation is to study interactions between electroencephalogram (EEG) and motor responses inhibition in normal, ADHD adolescents and adults. Method: 19 normal and 24 subjects with ADHD participated. The Go/NOGO tasks (adduction thumb of the right hand) were used. EEG (4-60 Hz) was recorded before with closed eyes (1), during realization GO (2) and NOGO (3) task. The Grand-average topographic maps of EEG spectrum were compared between experimental conditions 1-2, 1-3. TMS was applied for recording motor evoked potential (MEP) of M. Adductor policis. For detection signicant effect one-way ANOVA was used. Results: GO task. In normal subjects amplitude of MEP increased from rest (before task) - 2,10,3 mV to during task - 4,70,7 mV; in ADHD subjects - from 2,10,2 to 4,10,4 mV in these conditions. In normal subjects maximal decrease (6-7%) of EEG spectrum power were revealed in 8-10 Hz in especially in frontal and left parietal areas; maximal increase - in 36-47 Hz in left premotor and primary motor areas. In ADHD subjects maximal decrease of EEG spectrum power were detected in 8-10 Hz in all cortex areas, maximal increase in 36-47 Hz in vertex and parietal areas. NOGO task. In normal subjects amplitude of MEP decreased from 2,10,3 to 1,10,2 mV in ADHD subjects it has not changed. Maximal decrease of EEG spectrum power in normal subjects were detected in 8-10 Hz in left frontal area, minimal increase (\2%) of EEG spectrum power in 36-47 Hz - in premotor and primary motor areas. In subjects with ADHD maximal decrease of EEG spectrum power was kept in 8-10 Hz. In 36-47 Hz minimal increase of EEG spectrum power were revealed in all areas of cortex, especially in left hemisphere.

P-35 Pharmacological treatment: Children and adolescents III

P-35-01 Prolonged cognitive improvement of attention and inhibition in children with ADHD treated with OROS Methylphenidate H. Slama*, P. Fery, D. Verheulpen, P. Van Bogaert * Brussels, Belgium Objective: This study aimed at investigating the prolonged cognitive effects (i.e. 8 h after taking medication) of long-acting (Osmotic Release Oral System, OROS) Methylphenidate (MPH) on attention and inhibition, in children with Attention Decit Hyperactivity Disorder (ADHD). Indeed, despite a broad range of studies that have evidenced cognitive improvements with immediaterelease MPH in ADHD, little is known about the prolonged cognitive benets of OROS MPH, a once-a-day formulation. Particularly, given the advantages of OROS MPH (e.g. single daily dose) with similar safety and tolerability, studies are required to validate its prolonged action not only on behaviour but also on cognition. Method: We conducted a randomized, double-blind, placebo-controlled study in a between-groups design. Thirty-six boys (6-12 years) with ADHD inattentive or combined subtypes, good responders to immediate-release MPH, completed three tasks: a Counting Stroop (the child must count digits and avoid to read them) and two Continuous Performance Tests (CPTs) that require detection of low-probability targets (CPT-X) and target sequences (CPT-AX). The testing occured on the third day of treatment, 8 h after taking medication. ADHD children were also compared to forty-eight healthy boys matched for age. Reaction times (RTs) and coefcient of variation of RTs (CVs) in CPTs were analysed with repeated-measures ANOVAs. We subjected correct responses and false alarms data to an arcsine transformation. In the Counting Stroop, we calculated a RTs interference index to evaluate inhibition.

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212 Results: In CPTs, we found a signicant treatment effect on RTs (F(2,81)=3.837, p=.026) and on CVs (F(2,81)=6.039, p=.004). Planned comparisons indicated that ADHD children with OROS MPH had faster RTs and less RTs variability than ADHD children with Placebo or than controls. ADHD children with Placebo had similar RTs than controls but showed more RTs variability. No treatment effect on correct responses or false alarms was signicant. In the Counting Stroop, we found a treatment effect on the RTs interference index (F(2, 79) = 3.478, p = .036) with less sensibility to interference in the OROS MPH group than in the others. Conclusion: Our results yield prolonged cognitive benets of OROS MPH on both inhibition and attention, consistently with the literature on immediate-release MPH. Surprisingly, ADHD children with OROS MPH had better performance than matched healthy subjects. RTs variability in CPTs distinguished control and Placebo groups. Method: The medical records of outpatient clinic-rst time referralprimary school age children (7-14 years) were reviewed and; 67 children who received OROS-MPH (18-54 mg/once daily) and 47 children who received IR-MPH (15-60mg/in divided doses) (totally 114 children) to treat ADHD were recruited for the study. Baseline, 4th and 8th week assessment records were evaluated. Efcacy assessments included Turgay DSM-IV ADHD Screening and Rating Scale (T-DSM-IV) parent and teacher forms and Clinical Global Impression Scale-Severity and Improvement subscales. Safety assessments included laboratory evaluations, ECG, heart rate and blood pressure evaluations and a scale lled by the parents to capture side effects. Results: T-DSM-IV-S total scores of parent and teacher forms decreased signicantly in both groups in 8 weeks (p\0.001). No statistically signicant difference between OROS-MPH and IR-MPH groups were found according to mean total score changes of T-DSMIV scale parent forms in 8 weeks. According to teacher forms, OROSMPH was found to be superior to IR-MPH in the comparison of 8th -4th week mean total score change (p=0.008). OROS-MPH was again superior to IR-MPH in the comparison of 8th week-baseline and 8th -4th week mean inattention score change in both teacher (respectively p=0.007 and p=0.025) and parent forms (respectively p=0.015 and p=0.013). According to hyperactivity-impulsivity scores; only 4th week-baseline comparisons of parent forms revealed statistically signicant mean score change (OROS-MPH[IR-MPH, p=0.042). OROS-MPH and IR-MPH were both well tolerated with a similar side effect prole. Conclusion: OROS-MPH was found to be effective and safe in the treatment of ADHD symptoms among Turkish children.

P-35-02 The place of Methylphenidate in the treatment of ADHD. A Tunisian experience Z. S. Abbes*, S. Othman, F. Char, S. Halayem, A. Belhadj, A. Bouden, M. Halyem * La Manouba, Tunisia Objective: In this study, we propose to evaluate the effectiveness of methylphenidate in the treatment of ADHD in a tunisian sample Method: It is a cross-sectional study including patients, aged 6-16 years, who consulted our department between 2005 and 2010, and for whom the diagnosis of ADHD disorder was retained. These patients were evaluated by clinical examination and assessed with KiddieSADS PL, based on the DSM IV criteria. They were treated with methylphenidate at doses between 10 mg and 30 mg/day. Treatment response was assessed by a clinical examination of the child, a parent interview and criteria of the Kiddie-SADS PL. Results: 84 children with ADHD were examined: 85% with the mixed form, 10% with the predominantly hyperactive form and 5% with the predominantly inattentive form. 36% of these patients were treated with methylphenidate. Of the 31 children treated with methylphenidate, the majority of them responded to treatment after 2 weeks with increasing doses gradually. We have remarked a signicant improvement in cognitive functioning especially in boring. tasks. The patients were less distracted, working memory improved, as well as impulsivity. Among children initially treated with non-drug methods, only 20% had a favorable outcome. 6.5% have required the prescription of methylphenidate later. Conclusion: Methylphenidate is the treatment of choice in the ADHD by its effectiveness on the three main components of disorder. However, in our country, this treatment remains binding. Non-drug measures can hold their place in the management of this disorder.

P-35-04 Moderators of one-month treatment response to OROS Methylphenidate in subjects with ADHD in a naturalistic study O. Oner*, P. Oner, E. Cop, K. Munir * Ankara, Turkey Objective: We aimed to investigate the effect of maternal Attention Decit Hyperactivity Disorder (ADHD), antisocial behaviors and anxiety/depression ratings as well as age, gender, ADHD subtype and comorbidity on one-month treatment response to OROS methylphenidate in children and adolescents with ADHD in a naturalistic setting. Method: The study included 225 subjects (190 boys 35 girls; age 6-15 years, mean:9.4) treated with OROS methylphenidate (18-54 mg/day, mean: 29 mg/d; .4-1.4 mg/kg, mean:.86 mg/kg) for onemonth. Treatment response was dened as larger than 25% decrease in pre-treatment Conners Parent Rating Scale (CPRS) or Conners Teacher Rating Scale (CTRS) Hyperactivity (HA), Attention Problems (AP) and Behavioral Problems (BP) scores. Maternal ADHD, antisocial behaviors and anxiety/depression ratings were obtained by Adult Self Rating (ASR). Logistic regression analysis were computed in order to calculate the effects of gender; age; ADHD subtype (Combined, Predominantly inattentive, Predominantly hyperactive/ impulsive); comorbid Anxiety disorders, Learning Disorder (LD), Oppotinal Deant Disorder/Conduct Disorder (ODD/CD); maternal ASR Anxiety/Depression, ADHD and Antisocial scores. Results: Subjects with comorbid ODD/CD were less likely to have a 25% or more decrease in CPRS HA, AP and BP scores. Maternal selfreported antisocial behaviors were associated with less response to treatment in terms of CPRS HA and or BP scores. This was also evident in the CTRS BP score. Treatment response in terms of CTRS HA and AP scores were associated with LD comorbidity. Baseline rating scores were also important predictors of treatment response. Effects of age, gender and maternal anxiety/depression and ADHD were not signicant.

P-35-03 Comparison of the efcacy and safety of OROSmethylphenidate and IR-methylphenidate in Turkish children with Attention Decit Hyperactivity Disorder: A retrospective chart review E. S. Ercan*, O. Basay, E. Ercan, B. Kabukcu Basay, C. Aydin * Izmir, Turkey Objective: The aim of this study is to compare the efcacy and safety of OROS-methylphenidate (OROS-MPH) with immediate releasemethylphenidate (IR-MPH) in Turkish children with Attention Decit Hyperactivity Disorder (ADHD).

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213 Conclusion: Our results suggested that subjects with comorbid ODD/ CD or LD and whose mothers have higher antisocial behaviors might show less favorable short-term response to medication management with OROS-MPH. These subjects may need psychosocial interventions as an adjunct to medication. Method: In an open single-center study, 20 boys and girls of school age (6 to 13 years) diagnosed with ADHD according to DSM -IV and not able to tolerate or unwilling to take methylphenidate received EGb 761 tablets over a period of three to ve weeks. The initial dose of 40 mg twice daily was increased to 60 and 120 mg twice daily depending on efcacy and tolerability at weekly study visits. The primary outcome variable was parents assessment of change in their childrens attentiveness using the questionnaire FBB-HKS. Parents further assessed changes in hyperactivity and impulsiveness (FBBHKS), aggressive behaviors (FBB-SSV), strains on family life (FABEL), childrens perceived quality of life (KINDL), and childrens strengths and difculties (SDQ-D). Results: Improvement of the primary outcome variable attentiveness was statistically signicant between baseline and the end of treatment. Hyperactivity, impulsiveness, aggressiveness, social behavior and family life also improved. EGb 761 doses of 60 and 120 mg twice daily were established for 2 and 18 children, respectively. EGb 761 presented a favorable tolerability prole, no serious adverse events were observed. Conclusion: Ginkgo biloba extract EGb 761 at doses of 60 and 120 mg twice daily was shown to be clinically effective in improving ADHD symptoms in children and to be safe and welltolerated.

P-35-05 The clinical impact of switching ADHD patients from concerta to a second entry product: a pediatric practice review J. van Stralen* * Ottawa, Canada Objective: Regulators approve second entry products based on standard metrics of bioequivalence. In Canada, there has recently been approval of a second-entry product considered by current standards to be bioequivalent to a rst line treatment of ADHD; OROSMPH (Concerta). Presently, there are neither direct clinical studies comparing second entry products to Concerta, nor systematic followup of patients that are switched from one product to another. This review of a pediatric practice was undertaken to evaluate if the bioequivalence of these products would also translate into clinical equivalence. Method: Consecutive charts were reviewed from April to November, 2010. All ADHD patients treated during this time frame with Concerta were reviewed. Data extracted included: demographics, medication information (dosage, if switch occurred), general treatment information (i.e. change in medication or dosage, co-morbid diagnoses, additional medications and comments by patients, parents and legal guardians regarding the effects of medication) prior to and after medication switch. Quantitative and qualitative responses were categorized. ADHD destabilization was considered if the patient required a change in medication or dosage. Results: 162 patients prescribed Concerta were identied within the seven month period. 53 of those had tried the second entry product. Of those that had been switched to the second entry product, 45 (85%) destabilized with the switch. 42% indicated shorter duration of effect. After having tried, and been destabilized on the second entry product, when returned to Concerta, 78% stabilized back to their baseline. In comparison, of those that never tried the second entry medication, 26% destabilized. Conclusion: The diagnosis, treatment and stabilization of ADHD can be a lengthy process involving multiple health care providers and assessments. Once a patient is stable, with controlled symptoms, it is important that those involved (family/physicians/pharmacists and regulators) follow the same treatment plan and dont force medication switches prior to awareness of its effect. Destabilization results in high societal costs including those affecting health, education and lost productivity. This retrospective study indicates that the second entry product is not clinically equivalent to Concerta. Furthermore, it shows the importance of assuring clinical equivalence and education before modifying treatment plans.

P-35-07 Atomoxetine response in the inattentive and combined subtypes of Attention Decit Hyperactivity Disorder: A retrospective chart review E. S. Ercan*, B. Kabukcu Basay, E. Ercan, O. Basay, C. Aydin * Izmir, Turkey Objective: The DSM-IV-TR (American Psychiatric Association 2000) describes Attention Decit Hyperactivity Disorder (ADHD) as a heterogeneous disorder; providing diagnostic criteria for three subtypes: hyperactive/impulsive (ADHD/HI), inattentive (ADHD/I), and combined type (ADHD/C). Differences among the subtypes are well dened but there may be also differences in terms of treatment responses. The aim of this study is to assess the responses of ADHD/I and ADHD/C to atomoxetine treatment. Method: The medical records of outpatient clinic-rst time referralprimary school age children (7-15 years old) were reviewed and 29 ADHD diagnosed children (15 ADHD/I, 12 ADHD/C) who were treated with atomoxetine were recruited for the study. Baseline, 2nd, 4th, 6th and 8th week assessment records were evaluated. Efcacy assessments included Turgay DSM-IV ADHD Screening and Rating Scale parent and teacher forms (T-DSM-IV) and Clinical Global Impression Scale-Severity and Improvement subscales. Safety assessments included hemogram, blood chemistry, thyroid function tests, ECG, heart rate and blood pressure evaluations (baseline and 8th week) and a scale for capturing side effects lled by the parents at the 8th week. Results: 2 children stopped the medication with nausea and irritability and 27 children completed 8 weeks of treatment. Atomoxetine was found to be effective in both ADHD/I and ADHD/C groups. Atomoxetine also decreased the opposition deance subscale scores of T-DSM-IV (both parent and teacher forms) whereas it was not found to make statistically signicant difference in the conduct disorder subscale scores. Parent reports of T-DSM-IV differed signicantly among the ADHD/I and ADHD/C groups in hyperactivity and opposition deance subscales and total scale scores; ADHD/C types responded better to medication. Conclusion: Results of this study revealed that atomoxetine is effective both in ADHD/I and ADHD/C. Some differences in terms of treatment efcacy were found between the two subtypes.

P-35-06 Ginkgo biloba extract EGb 761 is effective and safe in the treatment of ADHD in children S. Klement, N. Bock*, A. Rothenberger * Gottingen, Germany Objective: Ginkgo biloba extracts have shown promise in treating symptoms of Attention Decit Hyperactivity Disorder (ADHD). Thus a dose-dening exploratory study was conducted to describe the therapeutic effects, safety and tolerability of Ginkgo biloba Special Extract EGb 761 in schoolchildren with ADHD.

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214 P-35-08 The functionality of ADHD comorbid ODD and/or CD children after 6 years: The treatment effect on prognosis E. S. Ercan*, O. Akyol, A. Kutlu, S. Kose, C. Aydin * Izmir, Turkey Objective: It is known that Attention Decit Hyperactivity Disorder (ADHD) persists through adolescence and adulthood and 15-80% of children diagnosed with ADHD continue to have the disorder in adulthood, depending on the diagnostic criteria used (Faraone et al., 2006; Hinshaw et al., 2006; Lahey et al., 2004). However, these ndings are mostly derived from follow-up studies from North America. The longitudinal outcome of ADHD children from nonwestern countries such as Turkey will be useful. It is also important to see the prognostic differences between ADHD?Oppositional Deant Disorder (ODD) and ADHD?Conduct Disorder (CD) cases. Method: The original sample was 120 ADHD children who were followed up for 18 months between 2001-2003. In this current study we aimed to evaluate the last psychiatric status, academic achievement, substance use and social functionality of sixty children who were interviewed 6 years before. The treatment duration is divided into three groups as under 15 months, 15-45 months and above 45 months. Results: Treatment duration of ADHD children has been found to be effective in many areas such as, academic success (p\0,001), repeating the class (p\0,03), being expelled or being suspended from school (p\0,007), being given disciplinary punishment (p\0,02), having an accident and plaster treatment (p\0,02) and smoking cigarette (p:0,02) scores between the groups. Conclusion: The symptoms of ADHD are associated with impairment in multiple domains of functioning. ADHD treatment has been found to be effective in many areas for Turkish children. Results revealed that longer treatment duration is signicantly correlated with better prognostic outcomes. was generally safe and well tolerated. Small mean increases in blood pressure and pulse were seen, but no trends of concern in ECG parameters were identied. Conclusion: In children with ADHD, treatment with LDX was associated with medium-to-large effect sizes on both subjective behavioural and objective performance assessments across the day.

P-35-10 ADHD diagnositics and treatment - experiences at a Hungarian psychiatric hospital and clinic for children A. Hajdu*, S. Olah, Z. Martsa, A. Batki, J. Gadoros * Budapest, Hungary Objective: This poster provides a summary of our experiences with ADHD children diagnosed and treated at Hungarys pre-eminent mental hospital for children. ADHD treatment at Vadaskert follows the international professional standard. A special program for ADHD patients provides the opportunity for intensive psychoeducational trainings for parents combined with a two-week inpatient behavioural therapy and medication for children. This poster gives an outline of this comprehensive program at Vadaskert and via our retrospective study compares and contrasts its results and efcacy with international ndings. Method: Our retrospective study analyzed data for all children under 11 years (n=303) diagnosed with ADHD in 2009, according to the following parameters: gender ratio, mean age, pharmacotherapy trials, frequency of consultations with physician, the number of families participating in our special ADHD program, co-morbid diagnosis, drop-out rate. Taking a client-satisfaction questionnaire at the end of the training (completed by 50 parents), we examined the efciency of the parental psychoeducational group. Results: In international comparison Hungarian parents are substantially more agreeable (at 75%) to involve their children in pharmacotherapy. In addition, approximately 15% of families took part in our 2-week in-patient behavioural therapy program combined with psychoeducational training. The drop-out rate from the time of the rst interview till the start of therapy was similar to that provided by international studies. Parental satisfaction with the program was extremely high. Conclusion: ADHD treatment is a complex issue crossing over various sectors (health, social work, education). Vadaskert strives to provide a sufciently comprehensive approach within the connes of the medical sector. However, Hungary will require a more inclusive, multi-sectoral model in order to accomplish higher efcacy in treating ADHD. While similar initiatives (like focused trainings of social workers and educators) are available at Vadaskert already, the scope and outreach should both be substantially wider to reach consequential impact.

P-35-09 Analysis of effect size in two clinical trials to evaluate the efcacy of lisdexamfetamine dimesylate in children with Attention Decit Hyperactivity Disorder M. Gasior*, S. Wigal, C. Richards, J. Gao * Wayne, USA Objective: To evaluate the efcacy of lisdexamfetamine dimesylate (LDX) across two studies in children (aged 612 years) with ADHD, using post-hoc analyses of effect size. Method: Study 1 was a phase III, randomized, double-blind, multicentre, forced-dose study, with subjects receiving LDX 30, 50, or 70 mg/day, or placebo, for 4 weeks. Study 2 was a classroom analogue study with an open-label, dose-optimization (LDX 30, 50, or 70 mg/ day) phase, followed by a randomized, double-blind, placebo-controlled, 2-way crossover phase. Outcome measures included the ADHD Rating Scale IV (ADHD-RS-IV) in both studies, and the Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) and Permanent Product Measure of Performance (PERMP) scales in Study 2. Effect size was determined by between-group differences and model-based standard deviation in Study 1 and by least-squares (LS) mean and standard error (SE) in Study 2. Safety/tolerability was also evaluated. Results: 290 subjects were randomized in Study 1, 117 in Study 2. All effect sizes (? and -) indicated improvement with LDX. Effect sizes based on the ADHD-RS-IV total score at treatment endpoint in Study 1 were 1.21, 1.34 and 1.60 in the LDX 30-, 50- and 70-mg/day groups, respectively, and -1.4 (mean size across the day) in Study 2. In Study 2, LS mean SKAMP total effect size (all measures for all participants at 7 time points across the day, up to 13 h) was -2.41 (SE 0.21); PERMP-Correct LS mean effect size was 1.83 (SE 0.18). LDX

Saturday, 28 May 2011, 14.3016.00 P-36 Pharmacological treatment: Children and adolescents IV
P-36-01 Compliance with Strattera (atomoxetine) in a patient support programme for Attention Decit/Hyperactivity Disorder in the United Kingdom A. Lenox-Smith*, J. Cooper-Jones, N. Savill, S. Cryer, J. Pelton * Basingstoke, United Kingdom Objective: Atomoxetine is a noradrenaline re-uptake inhibitor licensed for the treatment of Attention Decit Hyperactivity Disorder

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215 (ADHD) in children and adolescents. Atomoxetine has a slower onset of action than stimulants which can result in poor compliance at the beginning of therapy. According to Cegedim Strategic Data (July 2009), only 61% of patients remain on atomoxetine after the rst 3 months therapy. The Strattera Support Service (SSS) was set up in the United Kingdom to support carers of child and adolescent patients with ADHD for 12 weeks after initiation of atomoxetine with the aim of improving compliance. The objective of this analysis is to compare compliance rates of patients taking atomoxetine on the SSS with market research data taken from patients prescribed atomoxetine. Method: The SSS is an ongoing telephone service provided by Quintiles nurses on behalf of Lilly to carers of patients with ADHD. The frequency of calls provided by the SSS was agreed at rst contact, based on individual carer/patient needs. A record was kept of which patients were still on the programme and taking atomoxetine at weeks 4, 8 and 12. Compliance was assessed as the number of patients taking atomoxetine at 12 weeks on SSS. This was compared to the Cegedim naturalistic data. Results: From 1 January 2009 to 31 March 2010, 346 patients (300 male) starting atomoxetine were enrolled by their carers on the SSS programme. The mean age of patients was 10.5 years. At 12 weeks, 33 (9.5%) patients had discontinued atomoxetine. Conclusion: At 12 weeks, 90% of patients were compliant on the SSS compared to 61% of those prescribed atomoxetine in the general population (CSD data, 2009). The results suggest that patients enrolled on the SSS are likely to be more compliant and to potentially gain more benet from atomoxetine than patients not on the SSS. P-36-04 Risk factors for discontinuation of atomoxetine treatment in Attention Decit Hyperactivity Disorder (ADHD) D. Shin*, E.-J. Kim * Seoul, Republic of Korea Objective: ADHD is a chronic disorder, and pharmacotherapy is considered as rst-line intervention. The purpose oh this study was to nd the clinical characteristics of patients who had prematurely terminated atomoxetine treatment for their ADHD. Method: Patients who had been diagnosed with ADHD by DSM-IV and administered atomoxetine at least one time were included this study. Charts reviews were done for patients who had visited a psychiatric out patient clinic. Baseline severity of ADHD was assessed using ADHD rating scale and IOWA Conners Teacher Rating Scale. After 1 year of treatment, patients were divided into maintained group and terminated group.The association between discontinuation of atomoxetine treatment and covariates (age, sex, baseline severity of ADHD, tic disorder comorbidity, initial dose, side effect and comorbidity) was analyzed using Kaplan-Meier log-rank analysis and Cox regression proportional hazards model was constructed for multivariate analysis. Results: A total of 65 ADHD patients were included this study. After 1 year of treatment, 32 patients were maintained atomoxetine treatment and 34 patients were terminated. In the analysis of time to discontinuation based on the Cox model (proportional hazards regression), with tic disorder comorbidity, initial dose and age group as covariates, the hazard ratio was 2.43 for tic dirorder comorbid group versus tic disorder not comorbid group (95% condence interval: 1.02 to 5.7, p = 0.045), 5.1 for preschooler versus adolescent (95% condence interval: 1.07 to 24.3, p = 0.040), 7.3 for preschooler versus adult (95% condence interval: 1.20 to 44.9, p = 0.030). Whereas the effect of baseline severity of ADHD, initial dose, side effect and comorbidity were not signicant. Conclusion: Among ADHD patient, adolescent and adult patients had higher discontinuation rate than preschooler and children. Comorbidity between tic disorder and ADHD related with premature termination of atomoxetine treatment.

P-36-02 Attention Decit Hyperactivity Disorder, medication and adolescents: What do they have to say about it? J. Monteiro*, M. Pinto, V. Monteiro * Esmoriz, Portugal Objective: Considering adolescent people with Attention Decit Hyperactivity Disorder (ADHD), one difculty in measuring longterm stimulant medication efcacy may be poor adherence to treatment and their specic behavioural characteristics. Listen to the adolescent may be useful in offering more effective treatment with greater compliance. The objective of this study was to determine the levels of medication adherence, perceived symptom related with ADHD and its pharmacological treatment, as well as their future perspectives. Method: The study is based on a self-completed questionnaire administered to 70 patients, aged 12 to 17 years old, with ADHD who attended our Paediatric Neurodevelopment Consult. Anonymity was assured. Statistical analysis by SPSS v17. Results: As expected, the majority of our subjects were male with a mean age of 14 years old. All were under therapy with methylphenidate, half of them only on school days, with a non-adherence rate of 5.7%. About 61.2% also received educational and/or psychological support. More than half took the medication by themselves, reporting improvements in concentration (81.7%) and learning ability (67.1%), as well as better school results (55.7%). The most frequent side effects were loss of appetite, abdominal pain and headache. In order to have a higher educational degree, the majority wishes to continue at school. Currently, 55.7% continue to take medication in spite of having the option not to do so, furthermore, 64.2% desires to stop in the future. Conclusion: The results show that most of these teenagers are aware of their difculties as well as the benets that pharmacological treatment brings. Although this is a heterogeneous group (teens), they all still remain within the education system, which is, probably, the most important aspect that motivates them to continue medication in order to have a better social integration and a higher academic level as it was mentioned by most of them.

P-36-05 Prescription of melatonin in a clinic for severe ADHD A. Srensen*, P. H. Thomsen, I. R. Mller * Risskov, Denmark Objective: To investigate prescription of melatonin in an outpatient ADHD clinic. Method: Melatonin (Circadin) is indicated as monotherapy for shortterm treatment of primary insomnia, characterised by poor quality of sleep in patients aged 55 or over. The European Medicines Agency does not approve an indication for prescription of melatonin to paediatric patients. However, it seems that melatonin is frequently used in Danish child psychiatric clinics to treat sleep onset problems in children with ADHD. In many countries melatonin is an over-the-counter drug, which makes it difcult to study prescription of melatonin. In Denmark, melatonin requires prescription and is marketed as either: Melatonin 3 mg immediaterelease or Circadin 2 mg prolonged-release. All medical records at the outpatient clinic for children with severe ADHD at Aarhus University Hospital (n=578) were examined for prescription of melatonin. Results: All patients were prescribed methylphenidate. Melatonin was prescribed in 117 patients (20%) age 8-20 years. 114 (97%) in this group got immediate-release melatonin, of whom 98 patients (84%) received 3 mg and 15 (13%) received 4.5-6 mg. 4 patients (3%)

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216 were prescribed Circadin 2 mg. 477 (83%) of the group of outpatient children were males, and in the group of patients who were prescribed melatonin, 100 patients (85%) were males. 47 (40%) of the children prescribed melatonin were\13 years old. The diagnoses (ICD-10) of the children prescribed melatonin were: Hyperkinetic disorder without co-morbidity: 29 (25%), hyperkinetic disorder without hyperactivity: 9 (8%), hyperkinetic disorder and conduct disorder: 11 (9%), and hyperkinetic disorder and autism spectrum disorder: 25 (21%). The treatment with melatonin varied from 1 to 92 months, (mean 29.5 months 19.9 SD). Conclusion: Melatonin is frequently prescribed in children with severe ADHD in Denmark and treatment in this group is long termed and is given to children with and without co-morbidity. P-36-09 Optimal dosages of OROS methylphenidate for treatment response in children and adolescents with ADHD; Korean multisite open-label study D. Song*, B.-N. Kim, Y. S. Joung, K.-A. Cheon, D. Shin, Y.-J. Shin, H. J. Yoo, K. Jhung * Seoul, Republic of Korea Objective: This study was conducted to determine primary and secondary effectiveness and tolerability of OROS-MPH and its optimal dosage administered openly over a period of up to 12 weeks in drug-nave children with ADHD. Method: Participants(n=126), ages 6-18 years, with a clinical diagnosis of any subtype of ADHD were recruited from 7 medical centers in Korea. An individualized dosage of OROS MPH was determined for each subject based on operationalized criteria of Remission, dened as K-ARS\18 and CGI-I 1 or 2. If the change in ADHD symptoms from previous visit met the criteria for remission, 18mg/d or 27mg/d dosage of OROS MPH was added. Children were assessed with K-ARS, SRS, CGII, APRS, LPS in week 1, 3, 6, 9 and 12. Results: 66.0% of the subjects achieved the criteria for remission and the average of optimal daily dose for remission was to 34.3613.07mg/d(0.900.32mg/Kg/d) at the end of the study. The K-ARS scores at the end of week 12 showed statistically signicant (p\0.001) improvement. No serious adverse effects were reported and the dose did not have a signicant effect on adverse effects. Optimal dose was not signicantly different between ADHD subtypes, whereas signicant higher dose was needed in older aged groups. Conclusion: Effectiveness and tolerability of OROS-MPH in symptoms of ADHD, as well as academic performance and adaptive functions, is sustained for up to 12 weeks.

P-36-07 Development of a teaching aid to assist doctors, other health care providers and patients in using medications to treat ADHD A. Vincent*, D. Smith * Saint-Augustin-de-Demaures, Canada Objective: To improve the understanding of using medications for treating ADHD. Method: A chart was constructed using pictures of the various pharmacological agents for treatment of ADHD. The CADDRA (Canadian ADHD Resource Alliance Guidelines were added to the chart. The chart is avaible in both English and French. Results: This chart has proven to be the singe most accessed teaching aid for ADHD for both doctors and patients. It is updated on a regular basis Conclusion: This chart would be readily adoptable in many different countries and would be of great assistance in providing education to doctors, other professionals and patients.

P-36-10 Efcacy of slow vs. fast switching from stimulants to atomoxetine in children and adolescents with ADHD V. Porsdal*, E. Anand, D. Quail, M. Casillas, R. Escobar * Lyngby, Denmark Objective: To compare the efcacy of 2 switching approaches (fast vs. slow) from stimulants to atomoxetine (ATX). Method: Randomized, controlled, open-label, multicenter Phase IV study in 6-17 year old ADHD-patients, previously treated with stimulants and switched because of unsatisfactory symptoms and/or AEs over a period of 2 weeks in the fast, and over a period of 10 weeks in the slow group to a nal dose after 14 weeks of 1.2-1.8 mg/ kg/day ATX. Primary efcacy measure was the change from baseline in the investigator-entered ADHD parent rating scale (ADHD-RS) at Weeks 10 and 2. The switching strategy with better numerical values at Weeks 10 and 2 was declared at least similar if not better based on mixed-model-repeated-measurements (MMRM) analyses. AEs were assessed to evaluate safety. Results: The analysis comprised 111 patients (57 slow, 54 fast). The majority of patients (83.8%, n=93) were male and had combined-type ADHD (66.7%, n=74). Mean age was 11.5 (2.38) years. Patients most frequently received long-acting stimulants as previous treatment (78.4%, n=87). Mean baseline ADHD-RS total score was 38.0 (95%CI: 36.1; 40.0) in the slow and 36.0 (33.5; 38.5) in the fast group. Change after 2 weeks (MMRM) was -8.0 (-9.9; -6.0) in the slow and -8.1 (-10.1; 6.1) in the fast group, and -14.3 (-16.7; -12.0) and -15.0 (-17.4; -12.6), respectively, after 10 weeks. Improvements were sustained with ATX at week 14 (slow: -14.5 [-17.1; -11.9], fast: -17.4 [-20.0; -14.7]). Mean CGI-S improved by -0.7 (2 weeks) and 1.7 (10 weeks) in both groups. TEAEs were reported by 35 (61.4%) and 31 (57.4%) patients in the slow and fast groups respectively (p=0.702).

P-36-08 Use of Methylphenidate in children and adolescents with Attention Decit Hyperactivity Disorder: A study of 445 cases S. Antoniuk*, M. Wehmuth, M. C. Bromberg * Curitiba, Brazil Objective: To evaluate the clinical prole of patients with ADHD by comparison and to evaluate the drug treatment with different formulations of methylphenidate, including Ritalin , medication for immediate action (RIT), Ritalin LA , long-action SODAS formula (RITLA), and Concerta , long-action OROS formula (CONC). Method: We evaluated 445 patients of an outpatient clinic, between 4 and 18 years, all treated with methylphenidate. A questionnaire was given to parents. Data collected were: comorbidities, medication use, adverse events, clinical improvement and need to discontinue the medication. Results: RIT was the medication used in most cases, 67%, followed by CONC, used in 19% and RITLA, in 14%. Of the 445 patients, 96% had comorbidities, psychiatric disorders (47,5%) and specic learning disorders (92.6%) being the most frequent. 55% of the patients had adverse side effects, the most common being decreased appetite, anxiety, irritability, headache, depression, insomnia and staring. They occurred in 50% of the cases with RIT, 55% with RITLA and 58% with CONC. In 25% of the patients, the drug was discontinued; 53% of the parents reported improvement in the quality of life of the children (35% RIT 1x/day, 64% RIT 2x/day, 72% RITLA, 75% CONC.) and 75%, improvement in school performance (73% RIT, 87% RITLA, 75% CONC). Conclusion: Methylphenidate may be considered a safe medication for ADHD treatment. Despite the frequency of side effects, it shows satisfactory results, which are present in all the pharmaceutical forms.

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217 Conclusion: ADHD-RS total score improved in both switching groups. Efcacy of slow and fast switching from stimulants to ATX was similar over the study period. symptoms. Some of the symptoms that improved included the hyperactivity, getting off to sleep better, improved Tics. 90% of the children used Clonidine with another methylphenidate preparation. Children were reviewed 3-6 monthly and their blood pressure and growth monitored. The maximum dose of Clonidine used in the clinic was 100mcg in divided doses. None of the children on Clonidine had any side effects. Conclusion: Clonidine is effective in managing Children with ADHD and Comorbidities. Clonidine decreases hyperactivity, impulsivity and anxiety symptoms and is also effective in managing sleep problems in children with ADHD.

P-36-11 Raynaud0 s Syndrome and Methylphenidate: A report of two cases J. L. Fernandez Sastre*, R. Agueda, G. Flavio, L. Cristina, P. Diego * Vigo, Spain Objective: To describe Raynaud Syndrome as a side effect due to stimulants prescribed as treatment of patients with ADHD. Method: Literature on stimulants0 side effects treatment in patients with ADHD has been reviewed. We found a number of cases reporting Raynaud0 s Syndrome as a non-common adverse effect in these patients. We report two cases with diagnosis of ADHD who were undertaking methylphenidate and shown this Syndrome. Anamnesis and diagnostic trials conducted to the diagnosis of Raynaud Syndrome caused by psychostimulants. Results: Raynauds can occur as a primary or secondary condition. As a primary condition, it is not associated with any other disease and is often referred to as Raynauds disease. If its symptoms are associated with another health condition, it is referred to as Raynauds Phenomenon. Primary is more common than secondary Raynauds and usually less severe. In the last few years, rheumatologists have reported Raynaud Syndrome in patients who have been prescribed stimulants for ADHD. Conclusion: Raynaud Syndrome may be considered as a possible adverse effect caused by the treatment with stimulants. Further cases may broaden our knowledge on this topic.

Saturday, 28 May 2011, 14.3016.00 P-37 Pharmacological treatment: Children and adolescents V
P-37-01 Survey of clinicians medication monitoring practices, following treatment initiation in children with newly diagnosed ADHD - United Kingdom survey I. Takon*, S. Yarney, L. Watts * Welwyn Garden City, United Kingdom Objective: To examine the use of telephone consultations and face to face consultations in conducting active drug monitoring reviews Method: Professionals treating children for ADHD were identied through Clinicians network and professional bodies. Pretested questionnaires were emailed, posted or faxed to clinicians. Some clinicians were surveyed by direct contact through face to face interviews or telephone interviews. Questionnaires were also administered to Clinicians attending regional ADHD Training meetings. Survey of health professionals were conducted by regular mail, fax, email, telephone and face-face interviews. Information was collected on the Case load of the clinicians, timescales for review following initiation of medication, frequency of review, professionals conducting review, observations obtained at monitoring and clinicians satisfaction with medication monitoring practice. Results: A total of 53 completed questionnaires were received. 30/53 respondents (56.6%) had less than 200 patients in their case load. 36/53 (68%) were Community Paediatricians, 15/53((28%) were Specialist CA MHS Clincians. 68% of Clinicians reviewed patients within 4 weeks of starting medication. Medication reviews were conducted by a wide range of professionals including child psychiatrist, Paediatricians, Specialist Registrars and Nurses. There was variation in information requested prior to medication review. 34 clinicians requested information before review with 18/34 (53%) requesting information from the school and 18/34 (53%) requesting information from the parent/carerl. Fewer clinicians (20.5%) requested information from the Child and 14.7% requested information from the young person. Professionals who carried out telephone consultation, did so mostly with the family/carer (93%). Most clinicians felt satised about their medication monitoring practice with 28/53 respondents being satised to very satised. 17% of professionals were however not satised about their current monitoring practice. Conclusion: There is a need to develop standards of care for telephone consultations done for ADHD treatment monitoring.

P-36-12 Clinical use of clonidine in ADHD management: Report of experience from a specialist ADHD clinic in the East of England I. Takon*, R. Beets * Welwyn Garden City, United Kingdom Objective: To review the clinical use of Clonidine in patients seen in the East Hertfordshire Specialist ADHD Clinic between January 2010 and January 2011. Method: Case identication of Children on treatment with Clonidine was done through the clinic ADHD database and review of patient information at clinic attendance. The children had their medical records reviewed by the ADHD Specialist Nurse and relevant information extracted into a study proforma. Results: Ten children had been prescribed Clonidine as an adjunct medication in treating ADHD and Comorbidities. Clonidine was prescribed for Challenging behaviour, tics, Sleep difculties, persisting core symptoms of ADHD despite maximum levels of Methylphenidate. The age at ADHD diagnosis in the children ranged between 5-10 years. The age range of children prescribed clonidine varied between 6 -13 years. All the children on Clonidine had been previously prescribed a Methylphenidate preparation(short and long acting) for treating their ADHD symptoms.No cardiac investigations were carried out before commencing Clonidine and cardiac evaluation was mainly through clinical examination and none of the children had any cardiac concerns. All the Parents reported they noticed some improvement in the ADHD

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218 P-37-03 Measuring emotion regulation in children with ADHD: a pilot study of the emotional anker task V. Van Cauwenberge*, J. R. Wiersema * Ghent, Belgium Objective: Children with ADHD show dysregulation of behaviour and cognition, but less research has been conducted on emotion regulation in ADHD (Martel, 2009). The aim of this pilot study is to test an emotional version of the anker task as a measure for emotion regulation. In the anker task, a central target is either anked by congruent distractors or by incongruent distractors, requiring respectively the same or a different response. This task measures the amount of cognitive control that is needed to overcome the conict (congruency effect: performance decline on incongruent trials relative to congruent trials), and an emotional version may form a suitable paradigm to study emotion regulation. Method: We developed an emotional anker task, using different positive and negative emotional faces. We administered this emotional anker and a letter anker in typically developing children between 7 and 12 years old. We also included questionnaires measuring effortful control and emotion regulation. Results: We calculated the congruency effect for mean reaction time and mean percentage of errors. In the letter anker task, a congruency effect was found for error rate, however not for speed of responding. For the emotional anker task, no signicant congruency effects were found. The measures of the two tasks correlated positively. Inconsistent correlations were found between performance measures of both tasks and the scores on our questionnaires. Conclusion: From this study, it is not yet clear whether the emotional anker task may be a suitable paradigm to study emotion regulation in children with ADHD. The weak interference effects as found in the current study may be due to the relatively high proportion of incongruent trials that were included. Also, the emotional anker task may have been too difcult for children of this age. Further piloting is needed.

P-37-02 Assessment of atomoxetine effect in pediatric patients with Attention Decit Hyperactivity Disorder: a meta-analysis of consistency of 15 clinical trials in 4 geographic regions Y. Tanaka*, L. Jin, H. Upadhyaya * Greenwood, USA Objective: Atomoxetine has been approved as a treatment for ADHD in the United States, Europe and other countries. This meta-analysis was to assess the consistency of treatment effect and tolerability of atomoxetine in children and adolescents with ADHD across 4 geographic regions. Method: Data from 15 acute double-blind placebo-controlled trials were pooled (2 Asia, 4 EU, 1 Russia and 8 US), yielding 2569 pediatric patients with DSM-IV ADHD. Efcacy was evaluated using the ADHD Rating Scale-IV or SNAP-IV-ADHD. Consistency across 4 regions was assessed by the global method including an interaction test and Higgins I2. Consistency of one region versus other regions was assessed by a multivariate method based on the effect size of individual regions and pairwise differences. Results: Patient demographics were generally similar across regions. More patients from US, EU and Russia met diagnostic criteria for ADHD combined subtype and less for inattentive subtype, compared with patients from Asia. Asian patients had lower baseline ADHD total scores and hyperactivity subscores. After the 6- to 10-week acute treatment, atomoxetine signicantly improved ADHD symptoms compared with placebo, in all 4 regions. The treatment effect showed marginal inconsistency and moderate heterogeneity among 4 regions (percentage of patients achieving a 40% decrease from baseline ADHD scores, atomoxetine versus placebo: Asia 40%, 24%; EU 40%, 12%; Russia 54%, 33%; US 45%, 22%). Inconsistency in Asia versus others and in US versus others was observed. Completion rate was higher in Asia and Russia (both 94%) versus in EU (84%) and US (80%). The most frequent treatment-emergent adverse events overall were decreased appetite and headache. Conclusion: Atomoxetine was demonstrated as an effective treatment for ADHD in 15 clinical trials from 4 regions. The current metaanalysis has revealed a degree of heterogeneity in treatment efcacy across regions. Potential factors contributing to this heterogeneity will be discussed.

P-37-04 Children treated with pharmacotherapy for Attention Decit Disorder in Western Australia: Mental health problems and family functioning D. Silva*, R. Glauert, S. Houghton, S. Zubrick, B. Jongeling, M. Cooper, C. Bower * West Perth Wa, Australia Objective: To determine the degree of mental health issues in parents and children treated with medication for ADHD including the effect on family strain pre and post medication use. Method: Children who met the DSMIV or ICD10 criteria for ADHD and had commenced pharmacotherapy were identied by 8 Paediatricians across WA. A questionnaire completed by parents obtained information on maternal, paternal and child mental health conditions, medication use and Family Strain Index (FSI) prior to commencing and post medication. Results: 358 questionnaires were returned for analysis (81% response). 78% of affected children were boys and 82% of children were reported as having one or more co morbid mental health conditions. Fifty six percent of mothers and 34% of fathers were diagnosed with more than one mental health condition. Depression was reported in 43% of

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219 mothers and 21% of fathers. The majority reported both child and family functioned to be better on medication and long acting methylphenidate was found to be most benecial. Fish oils and/or alternative therapy were reported as benecial in one third of ADHD children. Conrmatory Factor Analysis on the FSI before medication was commenced for this sample showed robust scale reliability (Chi square=49.56; df=9; p\0.0001; PMSEA=0.113) with the European ADORE study. Both child and family functioning including the FSI signicantly improved (p\0.0001) following medication use. Conclusion: Mental health problems in parents and children with ADHD are common. Treatment with pharmacotherapy is reported to signicantly improve individual and family functioning. Better understanding and support needs to be provided to families and children with ADHD. 1mg/kg as a standard dose and applied exible dosing strategy. Baseline evaluation of demographic and lifestyle factors, SNAP-IV and CGI-S for ADHD severity, IQ, and sleep diaries for one week were performed. Dose of MPH was adjusted every week. Sleep diary was recorded by the parents or legal guardians every day. Weekdays and weekends bedtime, wake-up time, TST, and sleep latency were compared. The differences of changes in TST between two MPHs (OROS-MPH and Metadate-CD) group, two dose per kilogram (lower and higher), and three age (younger, middle and older age) group were compared. Results: 63 ADHD children nished all of the process. Weekdays and weekend bedtime, TST were signicantly changed from 1st week of MPH trial. Weekday wake-up time was signicantly delayed from 2nd week of MPH trial. Changes of TST between two MPHs, dose per kilogram were not signicantly different. Younger age children of ADHD were more decreased TST than middle age children. Conclusion: This study suggests that MPH itself has negative effect on the childrens sleep. It mainly delays bedtime and wake-up time and also decreases about 20-30 min of TST, regardless of duration of action, dose per kilogram of MPH. Younger children has more negative effect on sleep than other age group of children by the use of MPH and it is not related to dose of MPH.

P-37-05 Continuous Performance Test (CPT) as a quick instrument to assess the effectiveness of methylphenidate (MPH) in school age children with ADHD J. Boavida*, S. Nogueira, M. Almeida, E. Fernandes, C. Alfaiate, M. J. Seabra Santos * Coimbra, Portugal Objective: To evaluate the usefulness of a CPT as a simple method to assess the effectiveness of MPH in the performance of executive tasks. Method: 50 children were evaluated, aged between 8 and 16 years, diagnosed with ADHD, off and on a controlled release formulation of methylphenidate (MPH) (concerta). We used the Conners Continuous Performance Test (CPT II) Version 5.2 for Windows covering the following types of measures: Response Times - Overall Hit Reaction Time (HRT), Overall HRT Standard Error (SE), Variability, HRT by Block, HRT SE by Block, HRT by ISI, HRT SE by ISI (the program classies a reaction time less than 100 ms as a perseveration); Errors (omissions and commissions); by Block results; by ISI results (the change in reaction time and in consistency); and Signal Detection Theory Statistics (Condence Index that suggests closeness of the match to a clinical or non-clinical prole). functions: Memory, Attention, Executive functions, Language and Fine motor skills. Results: The rst raw results, seem to show that, in addition to parents and teachers clinical impressions, Conners CPT II can be a very helpful instrument in determining improvement or deterioration with stimulant medication. More specic results will be available at the end of April, in order to be included in this poster presentation. Conclusion: This program can be very helpful not only as a screening instrument for ADHD but also as an aid in monitoring MPH treatment effectiveness.

P-37-07 An open-label study of Metadata CD on the improvements of clinical symptoms and neurocognitive functions in Korean children and adolescents with Attention Decit Hyperactivity Disorder Y. S. Lee*, H. K. Yoo, B. S. Kim, Y. S. Joung, G. H. Bahn, D. H. Song, D. H. Ahn * Seoul, Republic of Korea Objective: This study aimed to investigate the efcacy and safety of Metadate CD (MCD) in Korean children and adolescents with Attention Decit Hyperactivity Disorder (ADHD). We also explored the effects of the drug on diverse neurocognitive functions. Method: Ninety-one subjects (mean age 8.6 2.2 years) with ADHD were recruited at 6 outpatient clinics in Seoul, Korea. We used the ADHD rating scale (ARS), clinical global impression (CGI) and comprehensive attention test (CAT) to measure the drug effects. Results: After 0.92 0.32 mg/kg/day of MCD were administered for 57.4 7.6 days, there was a 48.5% reduction in the mean total ARS scores (p \ 0.001). Fifty-seven subjects (64.8%) showed either much improved or very much improved outcome by the CGI-Improvement. The CGI-Severity of Illness also decreased from 4.7 to 2.9 (p \ 0.001). Errors and response time standard deviations of the CAT, sustained attention test to response task, anker test, and divided attention test decreased after treatment (p \0.05). Forward memory span of the spatial working memory test increased (p \0.05). Thirtyve patients (39.8%) experienced side effects, the most common ones were headache (14.8%), nausea (12.5%) and anorexia (9.1%). Conclusion: This open-label study suggests that MCD is effective and safe in improving the symptoms and neurocognitive functions in Korean children and adolescents with ADHD.

P-37-06 Effect of Methylphenidate on sleep parameters in children with ADHD W. S. Seo*, J. Y. Back, H.-M. Sung, T. Y. Choi * Daegu, Republic of Korea Objective: The primary aim of this study was to evaluate changes of bedtime, wake-up time, total sleep time (TST), sleep latency after taking MPH in children with ADHD. The secondary aim was to compare the difference of TST between intermediate- and long-acting MPH group, lower and higher dose of MPH group, and younger and older age group. Method: 93 ADHD children, aged from 6 to 12 years old, were enrolled this study. They were randomly assigned to long-acting (OROS-MPH) or intermediate acting (Metadate-CD) MPH. We set

P-37-08 Monitoring social behavior using the Child Conict Index in children with ADHD Treated with OROS Methylphenidate B. Schaeuble*, H. L. Starr, R. Armstrong, C. Damaraju, S. Ascher * Neuss, Germany Objective: This study evaluated social behavior of children treated with OROS methylphenidate.

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220 Method: Data from 2 open-label dose-optimization studies evaluating OROS MPH in children aged 9 to 12 years with ADHD (NCT00799409, NCT00799487) were pooled. OROS MPH 18-mg/d treatment was exibly dosed to a maximum of 54 mg/d. Subjects continued their optimized dosage for up to 6 weeks. The Child Conict Index (CCI),1 which captures onict/attention-seeking and negativity/withdrawal behaviors, was administered by telephone to parents/caregivers just before baseline, at each dosage-adjustment visit, and at the nal study visit. Changes from baseline total CCI scores were evaluated using paired Student t tests. Results: Of 167 subjects in the safety analysis set, 115 were boys and 52 were girls. Mean optimized OROS MPH dosage was 41.1 mg/d (SD=12.9). Mean baseline total CCI score was 8.5 (SD=4.22) for boys and 7.0 (SD=2.92) for girls. Statistically signicant (P\0.05) improvements in total CCI score occurred at the rst dosage adjustment visit (change of -1.9 [SD=4.24] for boys, -1.0 [SD=2.61] for girls) and at most subsequent dosage-adjustment visits for each gender group and dosage level (18 mg/d, 36 mg/d, and 54 mg/d). At the nal study visit, both boys and girls had statistically signicant improvements from baseline CCI scores (change of -6.2 [SD=3.99] for boys, -4.9 [SD=3.75] for girls; P\0.0001 for both). Two subjects discontinued because of adverse events (AEs) during the dosage adjustment period. AEs reported by C10% of subjects were headache, abdominal pain upper, decreased appetite, irritability, and initial insomnia. No serious AEs or deaths were reported. Conclusion: Statistically signicant improvement on the CCI occurred during the rst week of OROS MPH treatment and was sustained at the nal study visit for both girls and boys. No unexpected or severe AEs were reported. initial insomnia. Two subjects discontinued due to AEs. No serious AEs or deaths were reported. Conclusion: Behavior and performance improved during treatment with OROS MPH in children with ADHD with and without comorbid learning disability.

P-37-10 Pharmacological treatment outcomes in children compared to adolescents with ADHD transitioning onto OROS MPH B. Schaeuble*, M. Berek, A. Kordon, F. Mattejat, K. Rettig, M. Djelani * Neuss, Germany Objective: To explore differences in functionality and quality of life outcomes in children versus adolescents with ADHD transitioning from IR MPH, ER MPH or ATX onto OROS MPH Method: Pooled analyses of two similar 12 week, open-label, exibly dosed trials studying children (6-12 years of age) and adolescents (1318 years of age) with ADHD insufciently responding to current treatment transitioning onto OROS MPH. Outcome parameters included safety measures, Connors parents rating scale (CPRS), and functionality and quality of life outcomes (ILC) based on proxy assessments (parents). Results: 583 children and 239 adolescents (N=822, 85% boys) were analyzed. Adolescents were rst diagnosed at 10 ? 2.9 yrs compared to 7.3 ? 1.9 yrs in children (p\0.001). Co-morbid anxiety, OCD, ODD and conduct disorder were diagnosed at similar rates in both groups. Substance use occurred only in the adolescent group (p\0.001). Mean OROS MPH starting and nal dose were higher in adolescents (37.6mg/day vs 29 mg/day, respectively at start and 32.8 vs 41.9mg/day at endpoint). Mean treatment duration on study was longer in adolescents (87.4 vs 82.9 days, p\0.012). 61.5% of adolescents vs. 53.1% of children experienced an at least 30% reduction on CPRS (p=0.03) while having comparable baseline scores. ILC total score (proxy) was lower in adolescents at study start (p=0.009), but comparable at endpoint (p=0.607). Adolescents showed worse baseline scores (proxy) in school performance, family functioning, mental health, and global QoL (all p \ 0.008). Of these single items, family functioning continued to be lower in adolescents compared to children (p\0.001). Conclusion: Clinically relevant differences between children and adolescents with ADHD are present. Adolescents appeared to have a lower quality of life and functioning compared to children at baseline, however, they were able to reach comparable ratings at endpoint for most items. OROS MPH was generally safe and well tolerated.

P-37-09 Effects of OROS Methylphenidate (MPH) treatment on behavior and performance in children with ADHD with and without Comorbid Learning Disability B. Schaeuble*, H. L. Starr, R. B. Armstrong, C. Damaraju, S. Ascher * Neuss, Germany Objective: Learning disabilities (LDs) are more common in children with ADHD than without ADHD. We evaluated effects of OROS MPH on performance in children with ADHD with and without LDs. Method: We analyzed 2 double-blind, randomized, placebo-controlled, crossover, analog classroom studies evaluating OROS MPH in 912year-olds with ADHD (NCT00799409, NCT00799487).Subjects had Wechsler Abbreviated Scale of Intelligence scores[80 with or without mild/moderate math LD (Wechsler Individual Achievement Test2nd Edition Numerical Operations scores C71 and B85) and/or language LD (Gray Oral Reading Test uency or Comprehensive Test of Phonological Processing standard scores [4 and \8). Subjects took individually determined doses of OROS MPH for 6 wks, except on 2 laboratory school days when randomized to OROS MPH on day 1/placebo on day 2 or the reverse. Permanent Product Math Test number attempted (PERMP-a) and correct (PERMP-c) and Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) scores were measured on both days. Results: Of 139 subjects, 89 (64%) had no LD, 46 (33%) had LD, and 4 (3%) were undetermined. Subjects had greater LS mean PERMP-a and -c scores with OROS MPH than placebo. Treatment effects for PERMP-a occurred in subjects without LD (OROS MPH, 114.6; placebo, 82.2) and with LD (OROS MPH, 100.9; placebo, 81.6), P\0.0001. Treatment effects for SKAMP composite scores: subjects without LD (OROS MPH, 8.4; placebo, 19.5) and with LD (OROS MPH, 10.4; placebo, 19.2), P\0.0001. Similar patterns were seen in SKAMP attention and deportment scores. AEs in C10% of subjects: headache, upper abdominal pain, decreased appetite, irritability, and

P-37-11 Changes in functionality and quality of life aspects in children with ADHD after transitioning onto OROS MPH B. Schaeuble*, A. Kordon, M. Berek, F. Mattejat, K. Rettig, M. Djelani * Neuss, Germany Objective: To explore functionality and quality of life outcomes in children with ADHD transitioning from IR MPH, ER MPH or ATX onto OROS MPH Method: Pooled analyses of two similar 12 week, open-label, exibly dosed trials exploring clinical outcomes in children (6-12 years of age) with ADHD transitioning onto OROS MPH because of inadequate efcacy and/or tolerability. Outcome parameters included safety measures, Connors parents rating scale (CPRS), children0 s

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221 global assessment scale (C-GAS), and functionality and quality of life outcomes (ILC) based on children and proxy (parents) assessments. The ITT analysis included all subjects who had received at least one dose of OROS MPH and had at least one follow-up effectiveness assessment. Missing values were imputed using last-observationcarried-forward (LOCF). Relationships between functional and symptomatic parameters were explored using Spearmans rank correlation coefcients. Results: 583 children (86% boys) were analyzed (ITT population). Average OROS MPH dose increased from 29.1?11.7 mg/day to 32.8 ? 12.7mg/day at endpoint (p\0.0001). 20.6% terminated the study prematurely. All functionality and quality of life measures improved based on self and proxy assessments at endpoint (except for physical health; all p\0.001). School performance, social integration, pursuing interests and hobbies, mental health and decreased burden of disease were areas of largest improvements at endpoint in self and proxy ratings (p\0.0001). Mean change from baseline to endpoint in CPRS was -9.7?11.4 (p\0.001). Pre-post- changes of ILC and CPRS, ILC and C-GAS correlated modestly in proxy ratings (r=-0.57 and r=0.49, respectively). Treatment-emergent AEs occurred in 37.1% of patients. AEs [4% were insomnia (8.9%), involuntary muscle contractions (5.7%), anorexia (5.3%). Vital signs were virtually unchanged. Conclusion: Transitioning onto OROS MPH in children with ADHD was associated with a clinically relevant improvement in daily functioning, several aspects of quality of life and decreased burden of disease. OROS MPH was generally safe and well tolerated. K-CBCL and social skills of both SSRS (p\0.05) and MSSRS (p\0.01) without signicant improvement of ADHD symptoms. Conclusion: Results suggest that SST is an effective treatment for children with ADHD and AD in the improvement of social skills. In addition, SST could improve internalizing problems and ADHD symptoms. Further studies are required on the long-term effect of SST and to compare the effect of SST between ADHD group and ADHD with AD.

P-38-02 Roc and ash to the rescue: A web-based cognitive approach to literacy and ADHD S. Lim*, J. L. Kheng, Y. P. Ooi, L. Su, D. S. Sheng Fung * Singapore, Singapore Objective: This study is to examine the effectiveness of a web-based, role-playing literacy programme to improve literacy outcomes, and decrease the severity of attention symptoms in children with ADHD. Method: Eight children, aged 7-10 years old, participated in the study. They attended an outpatient child psychiatric clinic where they were clinically diagnosed with ADHD by child psychiatrists. They were also screened to be at risk for a reading disorder. All participants were administered the following instruments at pre-treatment, midtreatment (6-month), and post-treatment (12-month): 1) Wechsler Individual Achievement Test 3 (WIAT-III): Word Reading, Pseudoword reading and Spelling subtests 2) Child Behavior Checklist (CBCL) Participants received 40 weekly one-hour sessions of the web-based literacy instruction. The sessions were conducted over a period of 12 months. During each 1-hr session, participants spent 50 min on the web-based literacy games targeted at developing decoding and spelling skills. The participants also played working memory games that are integrated into the programme. The teacher then engaged the participants in 10 min of language activities. The teacher did not provide direct reading instruction during the treatment period. Results: A series of within - subject repeated measure analyses were used. Our ndings revealed that these children scored signicantly higher WIAT: a) word reading scores at post-treatment, and b) spelling scores at mid-treatment and at post-treatment (p\.05). Overall, we found that WIAT scores signicantly increase linearly over treatment time. They also scored signicantly lower attention problem scores at mid-treatment and at post-treatment (p[.05). Conclusion: Overall, preliminary evidence suggests improvements in literacy outcomes and reduction in the severity of attention symptoms following treatment. Our ndings also support the use of web-based technology in the multi-modal treatment of children with attention and reading problems.

Saturday, 28 May 2011, 14.3016.00 P-38 Non pharmacological treatment: Children and adolescents III
P-38-01 The effect of social skill training (SST) for children with Attention Decit Hyperactivity Disorder (ADHD) and Aspergers Disorder (AD); Preliminary study Y. S. Kwack*, J.-h. Shin * Jeju, Republic of Korea Objective: The purpose of this study was to evaluate the effect of social skill training for children with ADHD and AD. Method: Fourteen children aged 7 to 12 years participated in the cognitive-behavioral SST program at the outpatient division of childadolescent psychiatry once a week. SST was composed of 24- ninety minutes sessions for 6months. 9 children were diagnosed with ADHD and 5 children were diagnosed with ADHD and AD. The parents of the children rated Korea-Child Behavior Checklist (K-CBCL), Conners rating scales (CRS), Korean-ADHD Rating Scale (K-ARS), Social Skill Rating System (SSRS), and Matsons Social Skill Rating Scale (MSSRS) for evaluating the treatment effect before the rst session and after the nal session of the training. Results: All children showed signicantly increased scores of social activity competence and total competence (p\0.01) and showed signicantly decreased scores of depression/anxiety, internalizing problems and total problems (p\0.05) of the K-CBCL scales. Also, scores of SSRS and MSSRS were signicantly increased (p\0.001) and scores of CRS were signicantly decreased (p\0.05). In particular, the ADHD without AD group showed signicant improvement in total competence (p\0.05) of K-CBCL, ADHD symptoms of both CRS (p\0.05) and K-ARS (p\0.05) and social skills of both SSRS (p\0.001) and MSSRS (p\0.01). But the ADHD with AD group showed signicant improvement in total competence (p\0.05) of

P-38-03 Training parents of Indian children with ADHD M. Mongia*, R. Sadhu, M. Mehta, R. Sagar * Delhi, India Objective: The objective of the present study was to develop and evaluate the efcacy of a training module for 61 parents of Indian children (7 12 years old) with ADHD (ICD 10), to study the effectiveness of sequence of intervention and to create a support group for parents of children with ADHD Method: Randomized delayed intervention design was used. 61 children with ADHD who attended the Child and Adolescent Psychiatry Clinic at AIIMS were selected based on set inclusion and exclusion criteria. Two groups on methylphenidate were compared

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222 after they did or did not receive parent training. Structured, annualized training was carried out over 10 sessions spread over 2 and half months. The concept of ADHD, its signs and symptoms, course and outcome, treatment methods, resources available, behavior therapy and cognitive behavior therapy techniques for dealing with ADHD were introduced using didactic teaching and role plays. Assessment was carried out pre and post intervention (post 3 months and post 6 months) using MISIC, CBCL, CPRS, CTRS, ADDES, ANSERS. The pilot phase carried out on 20 subjects helped validate the intervention module developed. The results of pilot phase were incorporated in the nal study. Results: The results were arrived at using SPSS 15.0 using t tests for continuous variables and chi square test and once the groups were found to be comparable, analysis for cross over design was applied. Signicant improvement was noted on CBCL and CTRS (attitude toward authority subtest) post 3 months of intervention. On remaining measures i.e. CPRS, ANSERS & ADDES and the two remaining subtests of CTRS, the two groups were statistically similar. However, post 6 months the two groups were signicantly different statistically on all scales barring the performance subscale of ANSERS and group participation subscale of CTRS. Although overall improvement in behavior and functioning of children with ADHD was noted in both the groups, more improvement was seen in group 2. Effect of sequence of intervention could also be noted. Cross over design analysis indicated signicant differences in 2 groups post 6 months. Conclusion: Parent training module was successfully developed and validated through expert opinion and pilot study. Combined intervention with CBT based parent training and medication proved to be more benecial for children with ADHD. Parent support group was created and is being effectively utilized by parents of children with ADHD. Culture specic issues are discussed. neuropsychological and cognitive abilities such as sustaining attention or impulse control in comparison to other behavioural methods. However, classical group and parental skills trainings seem to be advantageous in changing general behavioural attributes.

P-38-05 The effectiveness of group parent management training on behavioral disorders among 4 to 10 year old ADHD children P. Houshvar*, S. Zarshenas, F. Behnia, E. Pishyareh * Isfahan, Iran Objective: Attention Decit Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders of childhood and adolescence. Although Stimulant Medicine and Occupational Therapy services have Important Role on Treating ADHD signs and symptoms, Psychosocial Interventions are needed to Improve Childrens Behaviors and Parent Child Interaction. Group Parent management Training is one of the most empirically supported psychosocial Intervention for most Population. The Object of the present Study is to investigate the Effectiveness of Group Parent Management Training on Behavioral disorders among ADHD children referring Occupational Therapy Centers. Method: In this interventional and queasy experimental Study, Using Simple Randomized sampling, 54 children with ADHD meet study criteria and their mothers were recruited from 7 Mental Occupational Therapy Clinics. They allocated into two Equal groups (n = 27). Both groups received routine Occupational Therapy and Medication. Parent management Training program using triple p manual (Sanders 2005) added to the Intervention Group program. These sessions lasted 2 h a week for 8 weeks. Data was collected from their mothers at baseline survey and eight weeks later, at the end of Intervention, by using 2 questionnaires: Demographic questionnaire and Conners Parent Rating Scale (CPRS 48). Statistical Analysis of data was done by Independent T test and Paired T test. Results: The Results of this study conrmed that although both Groups showed signicant improvement in all subscales of Behavioral questionnaire (CPRS) by using Paired T test, relative to control group, Intervention group made signicant improvements in Conduct subscale (P\0.001),Anxiety subscale (P\0.001),HI subscale (P=0.016),and Total (P\0.001). But their Psychosomatic subscale, Learning Subscale and Impulsion and Hyperactivity Subscale Didnt change clearly. Conclusion: 8 session Group Parent management Training is signicantly effective in decreasing Behavioral Disorders and anxiety Status of 4 to 10 year old ADHD children. Then this psychosocial Intervention could be used as an effective complementary method beside medication and Occupational therapy Programs.

P-38-04 Neurobiofeedback - therapeutic alternative or supplement? Inuence of neurobiofeedback on behaviour, impulse control and electroneurophysiology in ADHD children. E. Cionek-Szpak*, F. Poustka, C. Stadler, N. Panzer, M. Holtmann * Dusseldorf, Germany Objective: The evidence for neurofeedback (NBF), a behavioral therapeutic technique aiming at an improvement of ADHD core symptoms through the modication of neurophysiologic parameters, has further improved in the recent years. Which impairments, and to what extend, can be positively inuenced by NBF is still being investigated. Method: 24 children (age 7.2-12.1) with ADHD divided into two groups participated in this double blind controlled study and were integrated in a special daily clinic programm for 2 weeks. ERP, STOP test, TAP/CPT, parental, self and teachers rating scales were used as instruments for the comparison of patients facilities before and after 20 sessions of EEG biofeedback (experimental group) or a comparable computer assisted training (control group). Results: The neurobiofeedback group (NBF) showed a signicant reduction of errors in CPT/TAP and in STOP test which again signicantly differed from the control group. In the NBF-group, the amplitude of the stop signal correlated N2-ERP component showed an increase over frontal electrodes in the pre/post comparison. Such effect could not be observed in the control group. Children in both groups showed a signicant pre-post training effect and no signicant group differences in the rating scales. Conclusion: NBF is a promising approach for the treatment of ADHD. It seems to be signicantly more powerful in increasing

P-38-06 Efcacy of multimodal intervention for children with Attention Decit Hyperactivity Disorder (ADHD) An Indian study R. Gopalan*, A. Oommen, S. Srinath * Kota Kinabalu, Malaysia Objective: To nd the efcacy of multimodal intervention on attention decit and hyperactivity, behavioral problems in home and school situations and on academic achievement of children with ADHD and the impact of family stress and coping on the outcome of multi-modal intervention

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223 Method: Randomized allocation, 10 weeks of intervention, assessment at pre-intervention, re-assessment at one month of intervention and post assessment at the end of intervention by investigator, parent, and teacher and also by blind rater. A sample (N=40) of children aged 5-10 years, diagnosed as ADHD with or without comorbidity were randomly allocated to routine medical management with parent counseling (N=20) or multimodal intervention (routine medical management, parent training and attention enhancement training) (N=20). Results: Signicant improvement was noticed for both groups but multimodal intervention was superior to routine medical management and parent counselling in reducing ADHD symptoms, behavioural problems at home and school, and in improving academic performance. Effect size estimates and the rates of clinically signicant change also supported this nding. Parental stress did not predict the outcome of intervention Conclusion: Multimodal intervention was found to be promising in the treatment of ADHD. Individually tailored intervention is required for academic performance if comorbid learning disabilities are present P-38-08 Psychosocial Interventions Canadian ADHD Practice Guidelines (CAP-Guidelines, 2011): A Consensus- and EvidenceBased, Practical Resource for Physicians Assessing and Treating ADHD across the Lifespan G. Farrelly*, U. Jain, L. Hechtman, M. Weiss, D. Quinn, D. Smith, A. Vincent, J. Sadek, L. Jerome * Calgary, Canada Objective: To educate physicians who treat ADHD across the lifespan on the use of psychosocial interventions that can be easily incorporated into their busy daily practices. Research shows that combined therapy (multi-modal) using medication and psychosocial interventions is the most effective way to manage core symptoms of ADHD and resulting impairments. Method: To achieve this objective, the executive board of the Canadian ADHD Resource Alliance (CADDRA) added a new chapter on psychosocial interventions in their third edition of the CAP-Guidelines. This new chapter includes a general overview of psychosocial principles including psycho-education regarding ADHD, behavioural interventions, social interventions, psychotherapy, cognitive behavioural therapy, and educational/vocational accommodations. All authors are members of both the executive board and editorial committee of CADDRA and are experts selected on the basis of their contributions to treatment, education and research in the area of ADHD. They represent several different disciplines across Canada. The recommendations made are evidence- and consensus-based and peer-reviewed both in the US and Canada. Results: Physicians treating ADHD across the lifespan now have a comprehensive, evidence- and consensus-based summary of the most current interventions. Practical examples of each psychosocial intervention are clearly described for direct clinical application. Conclusion: Time constraints and perceived lack of knowledge hinder physicians from implementing research-based interventions. The CAPGuidelines 2011 can be easily incorporated into physicians daily practice, as part of a multi-modal approach for assessing and treating ADHD. As demonstrated in research, the combination of psychosocial interventions with medication improves not only the core symptoms of ADHD, but overall quality of life. This resource helps to bridge the gap between research and clinical practice and improve the patient-physician partnership, which is the cornerstone of quality patient care.

P-38-07 Social skills training and parental training plus standard treatment versus standard treatment of children with Attention Decit Hyperactivity Disorder: the SOSTRA trial O. J. Storeb*, J. Pedersen, M. Skoog, P. H. Thomsen, P. Winkel, C. Gluud, E. Simonsen * Holbaek, Denmark Objective: Attention Decit Hyperactivity Disorder (ADHD) children have difculties with social interaction. Several randomised clinical trials suggest that social skills training may help children with ADHD. Some studies have shown a connection between ADHD and disorganised attachment.The primary aim of the SOSTRA trial is to examine the effect of the combination of social-skills training and parental training plus standard treatment versus standard treatment alone in children with ADHD and their families on the outcome measures of ADHD core symptoms, social skills, and the attachment between the child and the parents. Method: The design is a randomised, two-armed, parallel group, assessor-blinded trial. Children aged 8 to 12 years with a diagnosis of ADHD are randomised to social-skills training and parental training plus standard treatment versus standard treatment alone. A sample size calculation estimated that at least 52 children must be included to show a 4-point difference in the primary outcome on the Conners 3rd Edition subscale for hyperactivity-impulsivity between the intervention group and the control group. The outcomes will be assessed 3 and 6 months after randomisation. The primary outcome measure is ADHD symptoms. The secondary outcome is social skills. Tertiary outcomes include the relationship between social skills and symptoms of ADHD, the ability to form attachment, and parents ADHD symptoms. Results: Baseline data and design of the SOSTRA trial will be presented. Of the 56 children randomised; 34 had ADHD as the only diagnosis; 22 had ADHD and a comorbid diagnosis. Most of the children suffered from unsecure/preoccupied, unsecure/dismissing, or disorganised attachment type at baseline. Many of the parents had symptoms which are coincident with an ADHD disorder. Conclusion: The study provides a basis for conclusions regarding the effects seen in connection with the primary aim of the trial, but only design and baseline information will be presented because this is an ongoing trial.

P-38-09 The effectiveness of a multi sensory therapeutic program in enhancing language skills for children with Attention Decit Hyperactivity Disorder (ADHD) T. El. Sayed Ahmad*, T. A. Karim * Salmiya, Kuwait Objective: The present study aimed to identify the effectiveness of multi sensory based on reading as an educational tool based on the employment of modern teaching techniques to enhancing language skills of children from the category of attention decit disorder and hyperactivity, were hired, the program of current thesis as a means of therapeutic tool by stimulating a number of senses to develop language skills, in an interesting and attractive way to exemplify their interests. Keywords: Attention Decit Hyperactive Disorder -Language Skills- Multi Sensory Program Method: The study sample consisted of two sets of children from the category of attention decit and hyperactivity, number (20) children (16) of males, and (4) females, were divided into two groups (experimental and control) and ofcer by (10) children in each group, ranging age time between the (7:6 years), located in the rates of

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224 intelligence over the medium category with an average natural intelligence (115:84). Results: The results indicate that practice with the multi-sensory therapeutic program was effectiveness to development of language skills of children with attention decit disorder and hyperactivity, where the value of the total scores in the telemetric in the experimental group is a purposed at the level (P[0, 05) indication of the parties. There is statistically signicant at a level (P[0, 01) in attention and listening, receptive language skills, which is statistically signicant at level (P[ 0, 05) in social skills and expressive language and pragmatics between the degrees of study groups (experimental and control) in telemetric, in the direction of the experimental group. Conclusion: The presence study proved the effectiveness of a multi sensory therapeutic program in enhancing language skills for children with Attention Decit Hyperactivity Disorder (ADHD). sounds, lights, touch and tactile, balance (vestibular stimuli) etc. These symptoms are as a result of sensory disintegration dysfunction. Occupational therapists usually employ sensory stimulation to enhance these problems. This study aimed to examine the inuences of such stimulation on children with ADHD. Method: An experimental method was used to achieve the objective of this study. A total of 30 children (aged 7-15) referred to the Roshd Occupational Therapy Center, which were diagnosed as ADHD were evaluated using a sensory integration prole, and was randomly assigned in two control (N= 7 M & 5 F) and intervention (N= 12M & 7F) groups. An individually designed intervention was applied for each child in intervention group, three sessions (45 min) per week, for three months. The control group was in waiting list and did not receive any intervention until the post test. All children in both groups were evaluated using (sensory processing disorder checklist and SOR) before and after the intervention. Results: The results showed a signicant decrease in sensory integration decient behaviors such as hyperactivity, low attention span, self injury behavior, biting hands, avoiding from others, throwing objects out, holding objects, aggression intervention group when compared to control-one. Conclusion: It can be concluded that by using appropriately designed sensory stimuli, we can reduce various symptoms in children with ADHD.

P-38-10 Promising results with a dietary supplement in the treatment of Attention Decit Hyperactivity Disorder (ADHD) in children B. Hackenberg*, C. Grylli, W. Schuhmayer * Vienna, Austria Objective: The benecial effects of w3/w6 polyansaturated fatty acids (PUFAs) make them a reasonable option for the treatment of ADHD. Products with high dosage w3/PUFA have been shown to exhibit favourable effects. By monitoring the effects of PUFA we wanted to investigate whether certain administration criteria could be associated with favourable results. Our hypothesis was that for mild cases of ADHD, PUFA alone with standard psychotherapy (SP) could result in a reduction of the symptomatology observed in these children, while for moderately severe cases standard medication regimes would also be required. Method: 39 various cases of children from 6 to 16 years of age with ADHD and at least one more associated disorder were referred to our hospital outpatient clinic either for initial treatment or for further treatment of insufcient therapy. All rst time treated children received PUFA and standard psychotherapy, while all other children received in addition to their previously given medication, PUFA (without any subsequent dose increase of their standard medication). Results: Of the 14 patients that received only PUFA and SP, 6 (43%) demonstrated a clear reduction of the ADHD symptomatology and they did not require any additional treatment. Of the 25 patients who were already unsuccessfully receiving standard therapy and received in addition to this PUFA, 13 (52%) exhibited a sufcient decrease in their symptomatology and required no further dose increase of their medication. Conclusion: Our data indicated that in milder cases of ADHD, PUFA plus SP clearly beneted these children. Furthermore moderately severe cases could clearly benet from the addition of PUFA to the standard medication by avoiding the necessary dose augmentation of the latter. Of interest the observed benecial results of PUFA included our patients with motor or speech disabilities and/or unspecic lack of attention as well as Autistic spectrum symptoms.

P-38-12 Effects of gum chewing on vigilance in children with ADHD L. Tucha*, T. A. Sontag, K. W. Lange, O. Tucha * Groningen, The Netherlands Objective: Impairments of attention are cardinal features of Attention Decit Hyperactivity Disorder (ADHD) and can seriously affect the daily life of children with ADHD. Despite effective treatment strategies, there is a need of further treatment options that can be added to available and well established treatments. Further treatment options are needed since available treatments are often time consuming, expensive and limited regarding their external validity. Recent research demonstrated that gum chewing has benecial effects on cognition including certain aspects of attention. Therefore, gum chewing may benet children with ADHD in situations requiring particular cognitive efforts. Method: In a crossover study, attentional functioning of 32 children with ADHD and 32 children without the condition was examined. All participants were assessed with chewing gum and without chewing gum. A computerized test was used for the assessment of vigilance and sustained attention. Results: The ndings of the present study suggest that gum chewing during task execution has detrimental effects on vigilance of both healthy children and children with ADHD. Sustained attention was not affected by gum chewing. Conclusion: Chewing gum, therefore, appears not to improve attentional performance in children with ADHD.

P-38-11 Sensory stimulation reduces symptoms associated with sensory integration deciency in Attention Decit Hyperactivity Disorder children H. Haghgoo*, H. Haghgoo, S. A. Hosseini * Tehran, Iran Objective: Children with ADHD may demonstrate various symptoms including: short attention span, sensitivity to different stimuli like

P-38-13 Parent training for preschool ADHD: research protocol for a randomised controlled, multi-center effectiveness trial of the New Forest Parenting Programme in a clinical sample of Danish children Objective: A research protocol for a study to: 1) Address the need for non-pharmacological treatment in young children with ADHD and 2) Address the need for the development of evidence-based psychosocial interventions in Danish child mental health services, through the

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225 implementation of the New Forest Parenting Programme (NFPP) (Sonuga-Barke et. al, 2001). Method: Design: A randomised controlled trial with two conditions (NFPP) and no treatment (Wait List Control (WLC)), with three time points to examine the effectiveness of the NFPP intervention: T1 (baseline), T2 (week 8, post intervention), and T3 (6 month f/up). Participants: 200 parent-child pairs will be recruited from two Danish CAMHS sites: BUC-Risskov and BUC-Glostrup. Randomisation will be on a 1:1 basis, stratied for age and gender. Recruitment will take place over 2 years. Results: NO results yet. This is a protocol for forthcoming research due to commence in 2011. The poster also outlines additional research components of the study, such as 1) Treatment Fidelity and 2) Neuropsychological functioning for treatment outcome. Conclusion: No conclusions yet: This is a protocol for forthcoming research. Lead investigator: Anne-Mette Lange, clinical psychologist, Investigator in charge: Professor Per Hove Thomsen. Both Department of Child and Adolescent Psychiatry, Risskov. The study will be supported by an external expert team consisting of Prof. Edmund Sonuga-Barke, Dr Margaret Thompson, and Ms Cathy Laver-Bradbury, from the University of Southampton. And Prof. David Daley, University of Nottingham. treatment of children with the dual diagnosis of epilepsy and ADHD is a difcult management for child neurologists. In fact, the Physicians Desk Reference advisable to use caution stimulants in children with epilepsy. Methylphenidate might reduce the seizure threshold. However, several studies demonstrated safety to use of methylphenidate in epileptic children. The aim of our study was to compare the effect of methylphenidate on response time (RT) prole in children with epilepsy and children with ADHD. Method: Two groups, each composed of 27 children aged 6-13 years performed a computerised attentional capture paradigm. The rst group included children with epilepsy which met DSM-IV criteria for ADHD. Seizures were controlled by anti-epileptic medication and EEG did not demonstrate any frequent or prolonged electrical discharges. The second group included children with ADHD. These groups were matched on age, sex and intellectual efciency. Errors, mean RT, intra-individual variability of RT and effect of the distractor on the RT were measured with and without methylphenidate. Results: Children with epilepsy make fewer errors (p\0.05) but their mean RT were slower than children with ADHD (p\ 0.01). Intraindividual variability of RT and effect of distractor were altered but did not differ between groups. Methylphenidate improves signicantly all parameters in both groups with a major effect on the RT variability (p\ 0.0001). None epileptic child had exacerbation of seizures following initiation of methylphenidate. Conclusion: Children with epilepsy and ADHD exhibit similar RT prole with ADHD on attentional capture paradigm children except for mean RT and errors. Methylphenidate is as effective in children with epilepsy and ADHD as in children with ADHD. P-38-16 Concerta XL treatment for Attention Decit Hyperactivity Disorder: A retrospective case review of clinical outcomes and treatment choice in a cohort of paediatric outpatients L. Pert*, C. Steer * Kirkcaldy, United Kingdom Objective: To analyse prescribing patterns, clinical effectiveness and side effects associated with Concerta XL (once daily prolongedrelease methylphenidate [MPH]) in a paediatric neurodevelopmental clinic. Method: Retrospective case le review of patients with Attention Decit Hyperactivity Disorder (ADHD) aged 6-16 years, attending a paediatric neurodevelopmental outpatient clinic between April 2009 and June 2010, and treated with Concerta XL. Demography, reasons for treatment choice, previous and current medication, comorbidity, Clinical Global Impression-Improvement (CGI-I) score and reported/ observed side effects were recorded. Results: 178 cases were analysed; 159 patients (89%) were male. Mean age was 11.3 years. Most patients (n=165, 93%) had DSM-IV combined subtype ADHD. Reasons for initiating Concerta XL were extended-release (ER) advantage (n=178, 100%), carer/child preference (n=78, 44%) and side effects or lack of efcacy with previous ADHD medication (n=45, 25%) [in some cases more than one reason was provided]. Eighty patients (45%) had previously been prescribed ADHD medication, including immediate-release (IR)/ER 30/70 MPH (n=32), atomoxetine (n=22) and IR-MPH (n=19). Comorbidity was highly prevalent, particularly sleeping difculties (n=106), oppositional deant behaviours/conduct disorder (n=100) and learning disorders (n=81). Mean (range) Concerta XL dose was 50.6 (18-90) mg once daily, with mean (maximum) duration of treatment 31.2 months (8 years). Sixty patients (34%) were prescribed polytherapy, most commonly Concerta XL with atomoxetine (n=44) and IR-MPH (n=11). Almost all patients (n=170, 96%) took Concerta XL on seven days/week. CGI-I score was very much improved or much

P-38-14 Effect of the cognitive remediation at adolescent with ADHD S. Leopizzi*, N. Hadjikhani, B. Pierrehumbert, M. Bader, O. Halfon * Lausanne, Switzerland Objective: The claim of our study is to estimate the efciency of cognitive remediation on the anatomical substrate of working memory and executive functions (EF) and on symptoms in ADHD adolescent. Method: The study contains three axes of investigations, before and after cognitive remediation: I. A neuropsychological assessment (memory, attention, executive functions, Wechsler Intelligence Scale IV); II. A neuroimaging study with a functional magnetic imaging resonance (working memory task); III. The impact in the everyday life of ADHD adolescent and their parents (BRIEF, CONNERS, CBCL, BARKLEY). The investigations concern three adolescent groups, a group ADHD-MPH with training (N=20), a group ADHDMPH without training (N=15) and a control group with training (N=20). All the participants are from 11 to 15 years old. Results: The preliminary statistical analyses (no-parametric test, Wilcoxon) made with the group ADHD-MPH with training, show an improvement on the cognitive assessment (digit span forward, backward and visuo-spatial), a modication of brains activity, as well as a decrease of the cognitive symptoms in the everyday life. Conclusion: Afterward, these positive results could allow developing the use of this new approach still little known in a wider way in the professional network.

P-38-15 Attention Decit Hyperactivity Disorder in children with eplipsy: Response time prole and effect of Methylphenidate ` P. Berquin*, A. Delignieres, E. Bourel-Ponchel, A. Simonot, L. Querne * Amiens, France Objective: Attention disorders with or without hyperactivity are more frequent in children with epilepsy than in general paediatric population. Some epileptic children meet DSM IV criteria for ADHD. The

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226 improved in 98/175 patients (56%). Concerta XL was discontinued in 52 patients (29%), mostly due to lack of efcacy (n=37). Side effects were reported by 104 patients (58%); most frequent were appetite suppression (n=77) and insomnia (n=42). Conclusion: This naturalistic study supports evidence derived from randomised clinical trials that Concerta XL once daily is a generally well-tolerated and effective medication for the treatment of ADHD in children and adolescents. of the children and often persists until adolescence. Characteristic symptoms of ADHD are behavioural disturbances such as hyperactivity, attentional decits and an enhanced impulsivity. Method: The following study is based on an animal model for ADHD, in which the behavioural symptoms can be induced by early stress experience (1 h of social separation/day from day 1 to day 21) in the precocious rodent Octodon degus (trumpet-tailed rat). Early stressed degu pups display explorative hyperactivity and decreased attention towards species-specic vocalizations in a novel environment. These behavioural alterations are paralleled by a hypo function of several brain areas such as the prefrontal cortex and alterations of neuronal structure in this brain area. The described dysfunctions and decits can be partly normalized by treatment with methylphenidate. In the present study we used this animal model to investigate impulsivity and learning performance in a reward learning task. To test this, the animals had to learn a FCN (xed consecutive number) schedule in a skinner-box. To get a food-pellet as reward, the animal had to reach a dened minimum number of lever presses on the left lever (FCN-lever), before pressing the right lever (reward-lever). The number of lever presses and reward can be used as indicators for impulsivity and learning success. Results: We found signicant differences between the early stressed and control animals, since the stressed animals needed longer to reach the respective criteria, indicating decits in reward learning. Interestingly, this decit could be observed only in a subpopulation of the stressed animals, whereas another subpopulation obviously seemed to be resilient against the early stress experience. Furthermore the signicant lower effectiveness of the stressed animals in lever presses per reward indicated higher impulsivity of those animal. Overall, male animals showed a signicant better learning performance than the female animals. Conclusion: In conclusion, our animal model can provide new insights into the aetiology of ADHD in particular the underlying cellular and molecular neuronal mechanisms, as well as obtaining more detailed knowledge about the neuronal, neurochemical, and behavioral consequences of drug therapy in childhood and preadolescence.

Saturday, 28 May 2011, 14.3016.00 P-39 Experimental Models

P-39-01 A simple behavioral paradigm to measure impulsive behavior in an animal model of Attention Decit Hyperactivity Disorder (ADHD), the spontaneously hypertensive rats P. Kim*, I. Campomayor dela Pena, I. Choi, C. S. Choi, J. H. Ryu, J. H. Cheong, C. Y. Shin * Seoul, Republic of Korea Objective: A number of animal models have been developed for ADHD and the most validated are the Spontaneously Hypertensive rats (SHR). The SHR were readily shown to be impulsive in various delay discounting paradigms. However, there is a difculty in demonstrating impulsive actions in SHR using the 5-CSRT thus the SHR have been criticized to not fully represent the symptoms of ADHD. In the present study, we present a simple but effective behavioral paradigm that measures impulsivity in rodents. Method: In order to investigate the mechanism underpinning impulsive behavior, we developed new behavioral test to evaluate impulsivity that is called electro-foot shock aversive water drinking test (EFSDT). In this paradigm, thirsty rats should pass over the electro-shock grid to drink fresh water. In this study, our measures of impulsivity were: frequency in the water area (which is also the shock area) and the latency of the rst drink during the testing phase. Results: For sufcient validation of a paradigm, the differences on a number of general behaviors; basal activity, pain sensitivity or threshold, thirst, or anxiety level, which showed no differences between SHR and the normotensive control Wistar Kyoto (WKY). In the impulsivity paradigm, the SHR drank more, and thus experienced more punishment (electro-foot shock) than WKY rats. It was also shown that the rst drink latencies of SHR were shorter than the WKY counterparts. Conclusion: The present study has attempted to address the knowledge gap regarding the demonstration of impulsive actions in SHR. Impulsivity is shown by the inability of the animals to control their urge to drink, thus, they frequently crossed over the electric eld in order to obtain water. In the future, we can assess if the standard ADHD therapies (non-stimulant and stimulant medications) may prove effective in suppressing impulsive behaviors in SHR in this behavioral assay as well as evaluate the role of environmental and genetic risk factors of ADHD on the manifestation of impulsive behavior.

P-39-03 Behavioral phenotyping of heterozygous Snap25 knockout mice as a potential model of ADHD A. Post*, S. Popp, A. Schmitt, A. Reif, K.-P. Lesch * Wurzburg, Germany Objective: SNAP25 (Synaptosomal-Associated Protein of 25 kDa, part of the SNARE complex) is involved in axonal growth and synaptic plasticity, as well as in the docking and fusion of synaptic vesicles in presynaptic neurons necessary for the regulation of neurotransmitter release. In humans, different single nucleotide polymorphisms of SNAP25 have repeatedly been associated with Attention Decit Hyperactivity Disorder (ADHD). Thus, heterozygous () Snap25 knockout mice are a potential model of ADHD (complete knockouts are not viable). Method: We subjected Snap25 as well as their wild-type (?/?) littermates to a repeated, long-term Open Field testing in order to assess locomotor activity in a familiar environment. In addition, mice were tested for anxiety-like behavior using the light-dark emergence test. Results: There was no difference between groups in the rst Open Field test session; testing was accomplished over a period of one hour. However, in a second session 3 weeks later, Snap25 mice were signicantly more active than ?/? mice which implies hyperactivity in a familiar environment, as it can also be observed in children suffering from ADHD. In the light-dark emergence test, only female

P-39-02 Effects of early stress on impulsivity and reward learning in a novel animal model for ADHD J. Kunzler*, A. K. Braun, J. Bock * Magdeburg, Germany Objective: ADHD (Attention Decit Hyperactivity Disorder) is a heterogeneous behavioural disorder, which affects about 5-10 percent

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227 ?/? mice differed from the other groups and spent less time in the lit area arguing for decreased anxiety-like behavior (or increased novelty-seeking, respectively) in female animals. Conclusion: Hyperactivity in a familiar environment along with changes in the behavioral approach/avoidance system demonstrate that Snap25 mice exhibit some of the clinical features of ADHD. Further experiments, including the assessment of attentional decits and increased impulsivity as well as difculties in emotion regulation will be conducted to characterize the ADHD-like phenotype further. Choice Serial Reaction Time Task (5-CSRTT) to test whether these mice express impulsivity and inattentiveness (diagnostic features of ADHD) and perseveration (common in ADHD patients) and, if so, whether they are prevented by d-amphetamine (d-AMP). Method: Male NK1R?/? and NK1R-/- mice (129/SvXC57BL/6 crossed with an outbred MF1 strain) were trained in the 5 CSRTT (Oliver et al., 2009, Psychopharmacology, 204: 679 692). Their cognitive performance was then tested in sessions incorporating either a long-, or a variable-, inter-trial interval (LITI and VITI, respectively), which exacerbate premature responses (impulsivity) and omissions (inattentiveness). Once weekly thereafter, the mice were given either an i.p. injection of saline, or d-AMP (0.3 or 1 mg/kg), 30 min before the LITI/VITI test, or retested with no injection. The sequence of these four conditions was pseudo randomised, with each used once, only, in every mouse. Results: In the LITI test, NK1R-/- mice expressed greater perseveration than the wildtypes (?135%; t22=2.5, P\0.05): aggravation of this behaviour by saline injection (?48%) was prevented by d-AMP (F2,34=5.5, P\0.05). In the VITI test, %omissions, %premature response and latency to correct response were all greater, but %accuracy was slightly lower, in NK1R-/- mice than the wildtypes (P\0.05 for all). d-AMP abolished the genotype differences in %omissions and perseveration but exacerbated %premature responses in NK1R-/- mice. Conclusion: NK1R-/- mice express all core diagnostic features of ADHD: inattentiveness, impulsivity and hyperactivity. The decits in cognitive performance were inuenced in different ways by the task parameters, as was their modication by d-AMP. These ndings strengthen our proposal that NK1R-/- mice are a model of ADHD and that impaired function of NK1 receptor dependent systems can underlie this disorder.

P-39-04 Effects of BLK-030 and BLK-032 in a preclinical model of Attention Decit Hyperactivity Disorder. Comparison with mazindol, modanil and haloperidol J.-C. Bizot*, S. David, N. Fery, F. Trovero, M. Lecendreux, L. Ferrie, ` B. Figadere, E. Konofal * Orleans, France Objective: Impulsivity is a core symptom of Attention Decit Hyperactivity Disorder (ADHD). Previous pharmacological studies have demonstrated that various drugs used in ADHD treatment decreased impulsivity measured in juvenile rats (Bizot et al., Psychopharmacology, 2007; 193:215-23; Bizot et al., Neurosci Lett, 2011; 489:20-4). The aim of the present study was to examine the effects of two new stimulants, BLK-030 and BLK-032 on the impulsive-related behaviour in juvenile Wistar rats. These effects were compared with those of two stimulants which have been demonstrated as effective for the treatment of ADHD, mazindol (Cortese et al. Med Hypotheses, 2008; 70:12-6) and modanil (Modiodal) (Kumar. Drugs, 2008; 68:1803-39), and with those of an antipsychotic drug, haloperidol. Method: Juvenile Wistar rats were trained in a T-maze to choose between a small-and-immediate food reward and a large-but-30 s-delayed food reward. The effects of drugs were studied on the performance of animals at 33-35 day of age. Results: The number of choices for the large-but-delayed reward was increased by mazindol (1-10 mg/kg), modanil (64 mg/kg) and BLK032 (64-256 mg/kg) but was not signicantly altered by BLK-030 (64, 128 mg/kg) nor by haloperidol (0.01-0.3 mg/kg). Conclusion: Mazindol and modanil, but not haloperidol, improved waiting ability, i.e. decreased impulsivity. These results demonstrate that the T-maze procedure is a suitable tool to evaluate the effects of ADHD drugs on impulsivity. BLK-032 also improved impulsivity, suggesting that this compound could be an effective treatment for ADHD.

P-39-06 Link between insulin resistance, hypertension and Attention Decit Hyperactivity Disorder E. Grunblatt*, J. Bartl, A. Borst, D.-I. Iuhos, P. Riederer, M. Salkovic-Petrisic, S. Walitza * Zurich, Switzerland Objective: The spontaneous-hypertensive-rat (SHR) shares many behavioural characteristics of humans diagnosed with Attention Decit Hyperactivity Disorder (ADHD) and used commonly as an animal model. The aim was to nd a link between metabolic-syndrome (insulin-resistance), hypertension and ADHD. Method: We investigated 3 and 7 months old SHR and measured learning behavior, insulin receptor (IR)--subunit and glycogensynthase-kinase-3 (GSK3)--subunit levels in different brain regions, glucose-intolerance and blood plasma insulin level. Results: Using passive avoidance and Morris water maze tests all SHR showed signicantly worse learning success compared to the control animals. In all brain regions (frontal cortex, hippocampus and striatum) IR level was signicantly decreased in SHRs while phosphorylated IR amount was increased. A signicant decreased level of GSK3 in 3-month-old SHR in all investigated brain regions was found, but non signicant changes in phosphorylated GSK3. In 7-months-old SHRs we detected a signicantly increased level of phophorylated GSK3 in these regions. Glucose intolerance showed no signicant alterations, but plasma insulin level was signicantly increased in all investigated SHRs. Conclusion: In summary, we could show signicant alterations in IR, GSK3 brain amount and blood insulin level in SH rats compared to their control, which indicates a possible link between insulin signalling pathway and hypertension with ADHD.

P-39-05 The NK1 receptor knockout mouse model of Attention Decit Hyperactivity Disorder: effects of d-amphetamine on impaired cognitive performance/response control in the 5-Choice Serial Reaction-Time Task S. C. Stanford*, T. C. Yan, R. K. Weir, J. A. Dudley, E. M. Grabowska, Y. Pena Oliver, T. Ripley, S. P. Hunt, D. N. Stephens * London, United Kingdom Objective: Neurochemical abnormalities and the hyperactivity of substance P-preferring NK1 receptor knockout mice (NK1R/) resemble Attention Decit Hyperactivity Disorder (ADHD) (Yan et al., 2009, Neuropharmacology, 57: 627 635). Here, we used the 5

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228 P-39-07 Effect of atomoxetine on tyrosine hydroxylase (TH) in animal model of Attention Decit Hyperactivity Disorder: adult male Spontaneously Hypertensive Rat (SHR) S. Moon*, J. Min, C. Kim, G. Bahn * Seoul, Republic of Korea Objective: The Dopamine hypothesis, based on a dysregulation of dopaminergic neurotransmission, is the most widely accepted theory of the behavioral alterations underlying mechanisms in both ADHD patients and SHRs. To date the pathologic mechanisms of Attention Decit Hyperactivity Disorder (ADHD) regarding the atomoxetines effects on DA synthesis are not clear. The purpose of this study was to investigate the therapeutic effects of atomoxetine on motor activity in relation to Tyrosine hydroxylase(TH) expressions, the rate liming enzyme in Dopamine synthesis pathway, in an animal model of ADHD - the Spontaneously hypertensive rat(SHR). Method: The ADHD animals were randomly divided into four groups (n = 10 in each group): the untreated ADHD group; the 0.25 mg/kg/day atomoxetine-treated ADHD group; the 0.5 mg/kg/day atomoxetinetreated ADHD group; and the 1 mg/kg/day atomoxetine-treated ADHD group. The control group comprised 10 Wister-Kyoto(WKY) rats. The rats in the atomoxetine-treated groups received atomoxetine (Strattera, Eli Lilly Co., Indianapolis, IN, USA) orally once a day, for 21 consecutive days, at the groups respective dosages. We evaluated motor activity using an open eld test and determined the expression of TH in the PFC, striatum, and hypothalamus via immunohistochemistry. Results: The ADHD rats activity was higher than that of the control rats. Atomoxetine treatment decreased the ADHD rats activity in a timeand dose-dependent manner (F(4,45) = 42.178, p \ 0.001). The THimmunoreactive ber density in the prefrontal cortex (PFCs), striatum, and hypothalamus of the ADHD rats was signicantly lower than that of the control rats, whereas atomoxetine treatment signicantly and dosedependently increased TH-immunoreactive ber density. Conclusion: We found that atomoxetine treatment alleviated the hyperactivity of the adult male SHR, increased TH expression. Based on the present study, we can suggest that atomoxetine ameliorates hyperactivity through improving DA synthesis in the corresponding brain regions of ADHD patients. consistent with the ones described in children treated with ATX. In the mRNA microarray 114 genes were up-regulated (min. 2fold) and 11 genes were down-regulated (max. .5fold) in the prefrontal cortex of ATXtreated rats. We found a signicant increase in the mRNA and protein expression of SNAP-25 (synaptosomal-associated protein of 25 kDa) Conclusion: SNAP-25 is a core component of the SNARE docking complex that supports the fusion of neurotransmitter vesicles with the plasma membrane in presynaptic neurons. Its increased expression points to an additional active therapeutic mechanism of atomoxetine by inuencing exocytosis of neurotransmitters into the synaptic cleft. Interestingly, SNAP-25 has been replicated as candidate gene for ADHD. Therefore, a SNAP-25 polymorphism in children with ADHD possibly inuences the effectiveness of atomoxetine treatment.

P-39-09 Effects of acute and chronic methylphenidate application on free radical formation in rats H.-W. Clement*, O. Sommer, A. Hoinkes, P. Heiser, E. Schulz * Freiburg, Germany Objective: In many psychiatric disorders, among them ADHD, increased oxidative stress parameters are described. Methylphenidate (MPH) is thought to increase the levels of oxidative stress parameters such as lipid peroxides. Aim of our investigation was to measure reactive oxygen species (ROS) in microdialysate (striatum) in acute and chronically MP treated rats, as well as the antioxidative capacity in tissue of different brain areas. Additional analyzed metabolic parameters were glucose and lactate. Method: ROS were detected by electron spin resonance spectroscopy (ESR) infusing 1-hydroxy-3-methoxycarbonyl-2,2,5,5-tetramethylpyrrolidine (CMH, 5 mM) as spin probe via microdialysis cannula (infusion rate 1,5ll/min). Stereotactic implantation of the probe (CMA 12) was performed according to coordinates of Paxinos and Watson (Lewis rats 250g-300g). After wake up and following a 1h control period (Sampling time 60 min), a 3h experimental period was started by injection of MPH (1mg/kg; i.p). Lactate and glutamate were analyzed spectrophotometrically. Chronic MPH (1mg/day) treatment started with i.p. implantation of osmotic minipumps (Alzet 28 days) in young rats (150g-200g). Tissue (striatum, cortex, hippocampus and cerebellum) were prepared for measurement of glutathione, superoxide dismutase-, glutathione reductaseand glutathione-S-transferase activity by spectrophotometrical methods. Results: Using this drug concentration (1mg/kg MPH) no enhanced motor activities were observed even during continuous treatment. Acute MPH injection in conscious rats signicantly decreased lactate, glutamate and ROS in striatal microdialysate. Continuous treatment of MP signicantly increased reduced glutathione, GST and GR activity in striatum and partially in the hippocampus No signicant changes were found in cerebellum and cortex. No enhanced ROS or SOD activity could be monitored. Conclusion: Actue Methylphenidate affects cellular metabolism as well as the formation of reactive oxygen species in a protective manner. We found no changes in ROS formation or superoxide dismutase activity in different brain areas during long-time treatment.

P-39-08 Long-term oral application of Atomoxetine leads to increased SNAP-25 expression T. Lempp*, S. W. Tonnes, C. M. Freitag, G. Geisslinger, E. Niederberger * Frankfurt, Germany Objective: Little is known about the molecular mechanisms of the therapeutic effect of atomoxetine. Thus, the objective of this animal study was to determine the alteration in gene expression in the prefrontal cortex of Sprague Dawley rats (SD) after long-term oral administration of atomoxetine (ATX). The animal model was adapted closely to the treatment conditions used in ADHD patients in child psychiatry: preadolescent animals, long-term oral application once daily and comparable plasma levels. Method: We weaned male SD rats on day 21 post natum and administered ATX versus H2O per oral tube for a period of 3 weeks until the animals reached puberty. The plasma level was adjusted to established plasma levels in children treated with ATX. At the end of the treatment period we extracted the prefrontal cortex from treated animals and controls and compared gene expression on RNA level (genome-wide mRNA microarray, quantitative real-time PCR) as well as on protein level (Western blot analysis). Results: Administration of ATX to preadolescent rats p.o. once daily at a dosage of 0.05mg/kg body weight resulted in plasma levels, which are

P-39-10 Age dependent effects of Atomoxetine chronic treatment causes differential alteration of Monoaminergic transporters and postsynaptic proteins in rodents P. T. Udvardi*, S. Liebau, J. Dreyhaupt, J. M. Fegert, T. M. Bockers, A. G. Ludolph * Ulm, Germany Objective: Although the efcacy and safety of atomoxetine is well investigated in clinical trials, the underlying mechanisms of its effects

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229 still remain elusive. Existing in vitro results prove that besides the well-known inhibition of the norepinephrine transporter (NET) atomoxetine, a psychotropic substance used in the pharmacotherapy of Attention Decit Hyperactivity Disorder (ADHD), acts as an openchannel blocker at the N-methyl-d-aspartate receptor (NMDAR) (Ludolph et al., 2010). Here we present an in vivo study carried out to investigate atomoxetines effect on the developing and the adult rat brain. Method: Pregnant Sprague Dawley rats were treated with atomoxetine (3 mg/kg, i.p.) and sodium chloride (0.9%, i.p.) respectively. The study was conducted on E12 to E19 thus covering a treatment period equivalent to the human second to third trimenon of pregnancy. After the end of treatment male fetuses (E19) and dams were cerebroectomised. Hippocampus, prefrontal cortex, mesencephalon and the striatum were tested on gene-expression and protein-levels respectively. We focused our investigations on monoaminergic transporters, NMDAR subunits and members of the postsynaptic density. Results: Our in vivo study revealed no signicant alterations in geneexpression of the tested genes neither in the fetal nor in the adult rat brain. Nonetheless we found signicant changes of protein-level of monoaminergic transporters, NMDAR subunits and several scaffolding proteins of the postsynapse. Conclusion: Gene-expression analyses indicate that atomoxetine does not affect transcriptional regulation of the tested genes after i.p. treatment for the duration of 7 days. Although several proteins encoded by those genes seem to be altered after atomoxetine treatment. Since proteins of the postsynaptic membrane and density are affected as well, we conclude that besides the inhibitory action at the NET, mechanisms inuencing proteins at the postsynapse might play a role in the clinical effects of atomoxetine. and SHR, but only methylphenidate-treated Wistar rats, demonstrated methylphenidate-induced reinstatement. Conclusion: Methylphenidate treatment (within the clinical range) is reinforcing in both strains, with more profound effects in the normal (Wistar) vs. the ADHD animal model (SHR). To the extent that SHR suitably models ADHD, this study supports less dependence liability of clinical methylphenidate use in ADHD sufferers. Neurobiological and behavioral differences between SHR and Wistar rats are known to inuence responses to drugs in behavioral assays. Moreover, previous methylphenidate treatment may have caused strain-specic neuroadaptations leading to the manifestation of differential strain response to its reinforcing efcacy.

Saturday, 28 May 2011, 14.3016.00 P-40 Miscellaneous I

P-40-01 Hostility and anger expression at schoolchildren with hyperkinetic disorder M. Igor*, M. Inna * Kyiv, Ukraine Objective: This study compares the features of experience feelings of anger and the possibility of overcoming it in children and adolescents with hyperkinetic disorder (HD). Method: We examined 45 schoolchildren with HD and 104 with activity and/or attention decit, not reaching the gravity of HD of special school for learning disabilities. The control group included 95 healthy children. Screening of feelings of anger and its manifestations was carried out using Multidimensional School Anger Inventory (MSAI). Results: Hostile Outlook Index and Positive Coping of School Anger Expression Index were different in the comparison groups. The MSAI Hostile Outlook scores of children with hyperkinetic spectrum disorders were signicantly higher than that of the control group. The mean scores for the anger components did not statistically differ between the children with HD and comorbid socialized conduct disorder/oppositional deant disorder and different types of hyperkinetic spectrum disorders. This study suggests that the children with HD have a more hostile outlook towards school, which can lead to serious violations of school failure. Conclusion: Children with HD report more hostility towards school and a lower positive coping strategy for controlling anger in school. Early anger management training for schoolboys diagnosed as having HD may be a promising avenue for preventing more complicated medical and behavioral problems.

P-39-11 Methylphenidate treatment in the spontaneously hypertensive rat: Inuence on methylphenidate selfadministration and reinstatement in comparison with Wistar rats I. Dela Pena*, H. S. Ahn, J. C. Lee, C. Y. Shin, J. H. Cheong * Seoul, Republic of Korea Objective: The spontaneously hypertensive rat (SHR) is the most validated animal model of ADHD. Previously, we demonstrated that drug-naive SHR, relative to Wistar rats (strain representing normal heterogeneous population), showed increased sensitivity to the reinforcing effects of methylphenidate. Herein, we examined the impact of previous methylphenidate exposure (at its clinically relevant dose) to methylphenidate self-administration and reinstatement in SHR and Wistar rats (i.e. whether its reinforcing efcacy is strengthened or weakened by prior methylphenidate treatment), and investigate if the effects are different in strains. Method: Rats were administered intraperitoneally (IP) with saline or methylphenidate (2 mg/kg, 14 days) prior to self-administration tests. Then, they were trained to respond for methylphenidate (0.25 mg/infusion) under the xed ratio (FR1-FR3) and progressive ratio (PR) schedules. The behavioral response of rats to intravenous methylphenidate was later extinguished. Thereafter, they underwent reinstatement experiments, where the ability of noncontingent methylphenidate administration (2 and 5 mg/kg, IP) to reinstate previously extinguished drug-seeking behavior was investigated. Results: The reinforcing effect of methylphenidate was demonstrated in both strains administered chronically with saline and methylphenidate. However, previous methylphenidate exposure enhanced active lever responding in Wistar rats, and only in the FR schedule. In the PR schedule, saline-treated SHR obtained more methylphenidate infusions than methylphenidate-treated SHR. Saline-treated Wistar

P-40-03 Parenting stress in mothers of children with and without Attention Decit Hyperactivity Disorder (ADHD) S. Youse*, A. Soltanifar, S. Teimouri * Torbat - E-Jam, Iran Objective: This research was down to compare parenting stress in mothers with ADHD sons and normal ones. Method: This research is a causal-comparing study and the statistical universe was all mothers of 5 to 12 years old sons with ADHD who referred to child psychiatry clinics (Ibn-e-Sina and Dr Sheikh Hospitals) and all mothers of normal sons (5 to 12 years old) were selected in primary and Preprimary school at 4th educational area of Mashhad city, north-eastern part of Iran. Fifty mothers with ADHD

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230 children by at reached sampling and 80 mothers with normal children were selected by cluster sampling. Parenting stress Index (PSI) was used and data analyzed by descriptive and analytic statistical methods such as t-test in independent groups. Results: Results showed that there was a signicant difference between parenting stress (parents realm) and its branches in mothers of ADHD children and mothers of normal children (P\0.000). There was a signicant difference between parenting stress (childs realm) and its branches in mothers of ADHD children and mothers of normal children (p\0.000) and difference between parenting stress (parentchilds realm) and its branches in mothers of ADHD children and mothers of normal children was signicant too (P\0.000). Conclusion: Mothers with ADHD children had more stress compared with mothers of normal children which it is realized by parenting stress index. 2-minute period was rated on a 5-point-scale and correct solutions of math tests of a 2-minute-period were counted. Thus the optimal dose was determined. The results of QbTest (Motor behaviour, attention, the sum of both and reaction time variance) were plotted for the different doses. Du Pauls ADHD rating scale was given to parents before and 6-12 weeks after start of treatment with optimal dose. Results: The one way ANOVA shows signicant differences for all four doses. All QbTest results show a curvilinear course as seen by video-assisted observation (see gure). Parent ratings show remission at optimal dose. Conclusion: Video-assisted observation of involuntary behaviour in ADHD-children coincides with neuropsychological QbTest-features. Both show a curvilinear course which permits the determination of an optimal dose. Individual courses are more informative than absolute Qb-values.

P-40-04 Diagnostic indicators for multiple X and Y chromosome disorders in pediatric age A. Verri*, A. Cremante, F. Clerici, L. Nespoli * Pavia, Italy Objective: Sex chromosome aneuploidies (SCAs) are the most frequently occurring chromosomal abnormalities with an incidence of 1 in 400 births. Sixty-four percent of males with 47,XXY are never diagnosed (Visootsak, 2009) Aim of this paper is to evaluate how often developmental delay and behavioural problems can induce an early suspicion of this conditions. Method: The sample was composed by 48 subjects (mean age=23,5 yrs, range:1-55) with karyotype 47, XXY (77.1%), 49, XXXXY (6.2%), 48, XXYY (6.2%), mosaicism 47, XXY/48,47, XYY (4.2%), 48, XXXY (2.1%), 49, XXXYY (2.1%). Primary caregiver completed a comprehensive questionnaire detailing birth, medical, developmental and psychological history (Tartaglia, 2008). Results: Five subjects had a prenatal diagnosis (10.4%). In the postnatal group: 31/43 (72.1%) had a diagnosis before 18 yrs and 12/43 subjects (27.9%) had a late diagnosis. In the pediatric group (# 31), patients were diagnosed for learning disabilities/attention disorders, behavioural disorders in 41%; genital anomalies/dysmorphisms 33%; hypogonadism/puberal delay 13%; epilepsy 13%. Conclusion: Boys exhibiting developmental delay with learning and behavioural disorders should be considered for chromosomal analysis early in life. An early identication of the social and behavioral phenotypes in SCA may enhance the clinical treatment, anticipatory guidance throughout the lifespan.

Saturday, 28 May 2011, 14.3016.00 P-41 Miscellaneous II

P-41-01 Different expectations of AD(H)D medication by doctors and patients H. Niederhofer*, B. Mueller * Rodewisch, Germany

P-40-09 Video-assisted observation of facial expression and neuropsychological QbTest-features in children with ADHD share a curvilinear course and both of them indicate the same optimal methylphenidate dose H.-J. Kuehle*, P. Rautzenberg, R. Lefering * Gieen, Germany Objective: To test if neuropsychological reaction time features as measured by the QbTest coincide with self regulation features as seen by video assisted observation. Method: A clinical convenience sample of 12 ADHD-patients (6-12 years old, 2 girls and 10 boys) were recorded playing cards with their mothers and doing oral arithmetic exercises without and 1 h after intake of immediate released MPH. This is our usual procedure of dose determination. Afterwards they did the QbTest. Doses were augmented day by day for 2.5mg. Variability of facial expression of a

Objective: A cornerstone of the diagnosis of AD(H)D is the taking into account of different peoples judgements of the problems associated with AD(H)D. Only when the symptoms are deemed severe, not only by the doctor alone but also by a variety of assessors (parents, teachers and the child him/herself), does the diagnosis of AD(H)D generally lead to the introduction of multimodal therapy. This survey addresses the question of whether and to what extent doctors and parents expectations of AD(H)D medication differ. Method: 109 children with a conrmed diagnosis of AD(H)D and considered eligible for drug therapy with methylphenidate (MPH) were included in our survey. Using a questionnaire, we asked the treating doctor and parents about their expectations of AD(H)D medication and about the problems which were the deciding factor in their opting for drug therapy. Results: The treating doctors most commonly cited problems with the childs behaviour, immediately followed by problems at school and socially, as the reasons for prescribing a drug for AD(H)D. Parents predominantly endorsed medication because of difculties

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231 surrounding homework. The situation at school was much less the deciding factor in the prescription of MPH treatment for them than for the treating doctor. The parents generally expected AD(H)D drugs to alleviate AD(H)D symptoms much more markedly than did the doctors. This becomes particularly clear when assessing the effects of the medication on motor functions. The parents expected the medication to bring about a greater improvement in motor functions than did the doctors. Similar, although much less marked, trends were also recorded for the expected improvement in attention and impulsiveness. Conclusion: The result of this study shows that the surveyed doctors and parents expectations of MPH treatment are different. Doctors see more the complexity of the condition, while the primary concern for parents is concrete problems in direct contact with the child. P-41-02 Quality assured medical care for ADHD patients rst results of an agreement with health insurance funds to improve care in Germany C. Schaff*, D. Best, K.-P. Grosse * Weil Der Stadt, Germany Objective: An agreement on quality assured medical care for ADHD patients has come into effect in the German region of Baden-Wurttemberg in 2009. Eligible patients have to be insured with the so called Betriebskrankenkassen and should be not older than 18. The agreement combines a range of measures aimed at the improvement of medical care for ADHD patients, among them the formation of interdisciplinary teams of physicians and psychotherapists, comprehensive diagnostic measures before commencing treatment, precedence of non-medicinal therapeutic approaches and quality assured pharmacotherapy. Particular attention is paid to the integration of parents into the concept. The objective of the study was an evaluation of the rst year of the agreement, in particular relating to the successful implementation of the designated structures. Method: The descriptive evaluation is largely based on routine data provided by the Association of Statutory Health Insurance Physicians in Baden-Wurttemberg and relates to all participating patients and physicians. The pharmacotherapy evaluation is based on data of four participating health insurance funds, thus using a random sample of about 60 patients. Results: In the rst quarter of 2010 a total number of 981 patients and 157 physicians and psychotherapists had joined the agreement. 50% of participating patients are between the age of 9 and 12, the youngest being 5, the oldest 20. Among the most important ndings is the fact that the formation of interdisciplinary teams has in most cases been successful with 77 percent of physicians and psychotherapists working as part of a team and regularly holding case-based conferences for those patients whose treatment aims have not been met. Findings also show that a quality assured pharmacotherapy has been established with non-medicinal approaches being used preferentially. Conclusion: First ndings show that the agreement has been successfully implemented. After a thorough analysis in 2011 the transfer of the concept to the publicly nanced ambulatory care system in Germany is planned. P-41-03 Determining the effectiveness of living skills on reduction of morbid symptoms amongst students contracted Attention Decit Hyperactivity Disorder P. Azizikhereshki*, H. Azizikhereshki, M. Darini * Tehran, Iran Objective: Attention Decit Hyperactivity Disorder (ADHD) is one of the most common problems in childhood which its prevalence amongst the students is about 3 to 5 percent. The appearance of the symptoms of this disorder usually leads to students deciency in their education and also problems in their social contacts with their peers. Therefore, the purpose of this research is focused on determining the effectiveness of living skills in reducing the morbid symptoms amongst male students suffering from ADHD in the city of Tehran. Method: It should be mentioned that the adopted approach in this research is semi-experimental and its experimental design consist of pre-test, post-test with control group. The sampling method used in this research is random cluster sampling, accompanied with CSI9 questionnaire distributed amongst mothers owning ADHD children. Twenty four of the ADHD children were randomly chosen and placed into two groups, one as control and the other as experimental group. At the beginning both groups took the pre-test, and then the experimental group received living skills through 10 one- hour sessions. Upon the completion of the training phase, post-test was carried out for mothers of both groups and in the end. Results: The result which was obtained through covariance analysis proved the effectiveness of this approach to reduce the morbid symptoms of children. Conclusion: With regard to the effectiveness of this approach, widely execution of such training programs for living skills at schools is strongly recommended so that we can witness a considerable decline in the number of the students suffering from ADHD.

P-41-06 Challenges in ADHD knowledge transfer J. Sadek*, L. Hechtman * Halifax, Ns, Canada Objective: (1) To understand the perception of Psychiatrist as to why family physicians do not diagnose and treat Adults with ADHD. (2) To understand challenges in teaching ADHD to learners (residents & medical students Method: Twelve psychiatrists and leaders in the eld of ADHD across Canada participated in the study questionnaire. Participants were asked two questions: (1) Why family Physicians do not diagnose and treat Adults with ADHD (2) The challenges of teaching ADHD to learners (residents & medical Students). Data were collected and compiled by the investigators. Results: Obstacles why Family Physicians do not diagnose and treat Adults with ADHD included several categories: (1) Lack of knowledge and experience with ADHD: e.g. Misconceptions of what Adult ADHD entails, unaware of either diagnoses or treatment protocols, dont believe it exists, and lack of condence in treating the disorder or its co-morbidities. (2) Lack of support from specialists: e.g. Lack of mentorship or guidance, No ability to get expert psychiatrist back-up (3) Worry about prescribing controlled substances, e.g. Possible abuse of stimulant medication (4) Patients with ADHD too difcult, e.g. More complications, less compliance and more medico-legal problems. (5) Time and billing difculties The challenges of teaching ADHD to learners (residents & medical students) included: (1) Difculty in getting ADHD teaching particularly for Adults on the curriculum. e.g. ADHD is not seen as a priority. (2) Lack of specialty clinics for ADHD in academic facilities, e.g. This makes nding rotations or electives and supervision in ADHD training very difcult. Conclusion: It should be stressed that limitations of this survey include the very small number of experts polled. However, the results suggest that further work is required in many areas of ADHD teaching. More research is needed to identify possible solutions and develop effective approaches for ADHD knowledge transfer.

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232 P-41-07 Attention and executive function using nepsy in sickle cell anemia N. Abreu*, S. Nunes, D. L. Miranda, R. Lucena, A. T. Reis, A. Gramacho, N. Argollo * Salvador Bahia, Brazil Objective: To assess attention and executive function on sickle cell anemia (SCA) using NEPSY subtests, once patients with this disturb usually show problems on them which is very similar to patients with ADHD. Method: It is a case-control study. One-hundred three children (SCA=41; Controls= 62)were assessed for intelligence, attention and executive functions. All of them were assessed with an intelligence quotient test (IQ), and NEPSY subtests: Tower of London (TOL), Auditory Attention and Response Set (AARS), Visual Attention (VA) and Attention/Executive Function (AEF). To assess the true relative risk for these neuropsycological decits in SCA an odds ratio statistic was applied. Results: Participants with SCA showed no risk for decits for planning (TOL; .70, 95% Condence Interval: .258-1.467), visual attention (.68, 95% Condence Interval: .51-.90); SCA group showed risk for AARS (1,249, 95% Condence Interval: .974-1.602) and for AEF (1.47; 95% Condence Interval: 1.07 -2.01). Participants from control group showed, interestingly, IQ results with higher risk for less than 90. Conclusion: Our results showed that SCA can develop with some of attention and executive functions decits. We discuss the association of these results with frontal brain lesion and their relationship with medium cognitive functioning on these patients. Additionally we consider cognitive stimulation and neuropsychological results on SCA. the area of ADHD. Interested parties may be welcome to join the cooperation with own proposals.

P-41-10 Quality of Life and psycho-social outcomes as evolutionary aspects of ADHD J. Quintero*, M. Loro, N. Garcia Campos, B. Jimenez, K. Tajima, L. De Anta, M. Benitez, D. Zambrano, J. Correas * Madrid, Spain Objective: Attention Decit Hyperactivity Disorder (ADHD) is one of the most common childhood disorders and at least one- third to one-half will continue through adolescence and adulthood. Moreover it is important the high comorbidity not only in children, but in adolescents and adults. Therefore ADHD becomes especially important when we observed it as a risk factor for the development of another psychopathology that add more complexity to the diagnosis of children and adolescents and also adults, and confers an evolutionary risk throughout the lifetime of the person who suffers from it. Method: Correlational study with a sample of 378 patients diagnosed with ADHD in the childhood between1988 and 2000 who had initiated treatment after been diagnosed. 88 patients had been evaluated years after (2006) with ages between 18 and 33 years old. 85% of the patients in this study had had combined treatment. Results: The data found in this study show lower comorbidity than other published studies (36.4%), the anxiety disorders (11%) and depression (21%), were the most prevalent disorders. We found lower persistence of the diagnosis of ADHD in the adulthood too (15%). 62% of the patients use alcohol, and 14% other drugs, the cannabis was the principal drug consumed. Rest of data will be presented and discussed in the congress. Conclusion: This research shows data of the outcome of ADHD patients when they reach the adulthood, as this is a treated population, the results may lead to a possible protector role of the early intervention in ADHD.

P-41-08 Research settings in outpatient practices challenges and prospects P. Greven*, S. Buchmann, L. Beyer * Berlin, Germany Objective: Clinical research on topics of ADHD seems to be a domain of clinical departments. Available resources and academic background constitute important conditions for successful research. Nevertheless, there are certain aspects that could encourage efforts for more research activities in outpatient practice settings. Method: We want to introduce a regional network of outpatient practices in Berlin founded in 2004 initially cooperating for purposes of specialist training, continuing education in interdisciplinary clinical work, and quality management. Continuous work in collective representation of the network activities meanwhile has accounted for decided requests for more commitment to aspects of clinical research. Results: Research activities within the network initially would be limited to the well compensated participation in clinical trials according to GCP guidelines concerning for example various types of ADHD medication. Experience shows that large numbers of cases, high personal continuity of specialist experience and staggering commitment from the side of study subjects constitute a very fruitful foundation for successful research projects. Still, the lack of academic background and human resources concerning methodological aspects has posed an obstacle for the development of more sophisticated research questions until recent time. Conclusion: A current cooperation project with a Berlin university reveals challenging occasions to bring together broad clinical experience and large data pools on the one hand and methodological know-how as well as academic background on the other hand in order to facilitate novel opportunities in health care research especially in

P-41-11 Outcomes of peripheral social communication clinic in Midessex,UK for children suspected to have a diagnosis of Autism spectrum disorder. P. Sahare*, L. Murtaza * Braintree, United Kingdom Objective: The peripheral social communication clinics in Midessex, UK were started in April 2008 in 3 different patches to reduce the number of children coming to Moulsham Grange Development Centre unnecessarily for ADOS (Autism Diagnostic observation schedule) asessments. The main aim of this study was to 1) To see whether we have been successful to reduce the workload on Moulsham Grange Development Centre for multidisciplinary assessment. 2) To identify the outcomes of assessment at the peripheral social communication clinic. 3) To see what tools were used for onward referral to the multidisciplinary clinic. 4) To see the outcome of children referred to the multidisciplinary clinic for ADOS assessment Method: Data was collected retrospectively from the central data base available at the Moulsham grange development centre for the studyj period between April 08 to November 09 and also from clinic notes. The outcomes studied were 1) Workload on the peripheral social communication clinics. 2) Outcomes of peripheral social communication clinic 3) Outcome of children referred to multidisciplinary clinic at Moulsham grange development centre. 4) Tools used for referral to the multidisciplinary clinic.

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233 Results: 1) A total of 130 children were seen from April 08 to November 09 in 3 peripheral social communication clinics. 2) Majority of children seen were in the 5 to 10 years age group 3) General Practitioners followed by schools were the sources of referral in the majority of children. 4) ASD, communication problems and behavioural problems were the main reasons of referral 5) Out of the 130 children seen at the peripheral social communication clinic 55% were managed locally and 45% were referred onwards to the multidisciplinary clinic. 6) 52% of the referral to multidisciplinary clinic were diagnosed with either ASD or social communication and interaction difculties. 7) Majority of children diagnosed with ASD had history suggestive of difculty with social interaction, social communication difculties, more reports were attached and associated conditions were less common in this group of children. 8) The common tools used at the peripheral social communication clinic were relevant history, social communication questionnaire, school reports and clinic observations for onward referral. Conclusion: The results show that Peripheral social communication clinics should continue as they reduce the workload on the multidisciplinary clinics (ADOS clinic) at Moulsham grange development centre. This model of delivery of services can be used as a screening tool to reduce the workload on the ADOS clinic for diagnosis of Autism.

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